Provider Demographics
NPI:1962776757
Name:WIMBISH, JESSICA ERIN (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ERIN
Last Name:WIMBISH
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 1:119 LONE LN
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9538
Mailing Address - Country:US
Mailing Address - Phone:610-390-4589
Mailing Address - Fax:610-748-4017
Practice Address - Street 1:1403 N CEDAR CREST BLVD STE 160
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2331
Practice Address - Country:US
Practice Address - Phone:610-390-4589
Practice Address - Fax:610-351-3971
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAJ010326111NR0400X
PADC010534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation