Provider Demographics
NPI:1902059850
Name:LEAVEY CARUSO, JESSICA (DC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEAVEY CARUSO
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 1:25 NASHUA RD
Mailing Address - Street 2:SUITE F2
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3446
Mailing Address - Country:US
Mailing Address - Phone:603-434-3456
Mailing Address - Fax:603-434-3469
Practice Address - Street 1:25 NASHUA RD
Practice Address - Street 2:SUITE F2
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3446
Practice Address - Country:US
Practice Address - Phone:603-434-3456
Practice Address - Fax:603-434-3469
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7370105111N00000X
MA3154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor