Provider Demographics
NPI:1760136337
Name:BENTLEY, JESSICA MEE-LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MEE-LYNN
Last Name:BENTLEY
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 1:2239 MOORPARK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2661
Mailing Address - Country:US
Mailing Address - Phone:504-452-4402
Mailing Address - Fax:
Practice Address - Street 1:2239 MOORPARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2661
Practice Address - Country:US
Practice Address - Phone:504-452-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor