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Individual

DR. JESSICA SHELLEY RIEDISSER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.C.

Contact information

Practice address
1159 BRYAN RD, O FALLON, MO 63366-3459
(636) 240-8989
(636) 240-6889
Mailing address
1159 BRYAN RD, O FALLON, MO 63366-3459
(636) 240-8989
(636) 240-6889

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2003006354
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000259375050
MEDICARE INVIDICUAL PTAN, ANOTHER FORMAT
MO
01
185420
BLUE CROSS BLUE SHIELD
MO
01
259375050
MEDICARE INDIVIDUAL PTAN NUMBER
MO
01
696970
ACN GROUP
MO
01
739074
HEALTHLINK
MO
01
7590746
AETNA
MO
Enumeration date
09/13/2006
Last updated
09/11/2023
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