Provider Demographics
NPI:1528096807
Name:MONTESANO, JESSICA LYNN (DC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MONTESANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9104 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6443
Mailing Address - Country:US
Mailing Address - Phone:918-461-9490
Mailing Address - Fax:918-461-9690
Practice Address - Street 1:9104 E 62ND ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6443
Practice Address - Country:US
Practice Address - Phone:918-461-9490
Practice Address - Fax:918-461-9690
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU79898Medicare UPIN
OK122709309Medicare ID - Type Unspecified