Provider Demographics
NPI:1881087633
Name:ENDERBY, JESSICA L (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:ENDERBY
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 1:1415 BOND ST
Mailing Address - Street 2:SUITE 171
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2388
Mailing Address - Country:US
Mailing Address - Phone:331-204-6196
Mailing Address - Fax:
Practice Address - Street 1:1415 BOND ST
Practice Address - Street 2:SUITE 171
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2388
Practice Address - Country:US
Practice Address - Phone:331-204-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1548703549OtherGROUP NPI