MEDICARE: JEAN ACHTERBERG DC

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	111N00000X	Chiropractor	7256	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	605779	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306052303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN ACHTERBERG DC

Provider Business Mailing Address
First Line	:	3003 LYNDON B JOHNSON FWY STE 122
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7773
Country	:	US
Telephone Number	:	972-406-8786
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 LYNDON B JOHNSON FWY STE 122
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-7773
Country	:	US
Telephone Number	:	972-406-8786
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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Directions to “ JEAN ACHTERBERG DC” Practice Location

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