Provider Demographics
NPI:1902075104
Name:MEEKS, JESSE L (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:L
Last Name:MEEKS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 2ND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6345
Mailing Address - Country:US
Mailing Address - Phone:801-334-8226
Mailing Address - Fax:
Practice Address - Street 1:460 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-6345
Practice Address - Country:US
Practice Address - Phone:801-334-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT286019-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU6486Medicare UPIN