MEDICARE: JEFFREY CARL PEDERSEN D.C.

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	4106	TX

General Provider Information

NPI Number	:	1639161516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY CARL PEDERSEN D.C.

Provider Business Mailing Address
First Line	:	2920 W PARK ROW DR
Second Line	:	#100
City	:	PANTEGO
State	:	TX
Zip	:	76013-2041
Country	:	US
Telephone Number	:	817-277-1111
Fax Number	:	817-861-4593

Provider Business Practice Location Address
First Line	:	2920 W PARK ROW DR
Second Line	:	#100
City	:	PANTEGO
State	:	TX
Zip	:	76013-2041
Country	:	US
Telephone Number	:	817-277-1111
Fax Number	:	817-861-4593

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/29/2025

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