Healthcare Provider Details

I. General information

NPI: 1235850330
Provider Name (Legal Business Name): JESSICA CHRISTINA MIJARES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E STACY RD
ALLEN TX
75002-8734
US

IV. Provider business mailing address

2124 CORAL CT
IRVING TX
75060-7343
US

V. Phone/Fax

Practice location:
  • Phone: 972-525-7246
  • Fax:
Mailing address:
  • Phone: 972-302-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: