MEDICARE: DR. JESSICA JEAN FAULKENBERRY DC, MSFN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor	15044	TX
2	111NN1001X	Nutrition Chiropractor	15044	TX
3	111NP0017X	Pediatric Chiropractor	15044	TX
4	111N00000X	Chiropractor	15044	TX

General Provider Information

NPI Number	:	1205580594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA JEAN FAULKENBERRY DC, MSFN

Provider Business Mailing Address
First Line	:	3619 SAVANNO LN APT 7302
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9689
Country	:	US
Telephone Number	:	817-919-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	3619 SAVANNO LN APT 7302
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9689
Country	:	US
Telephone Number	:	817-919-8879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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