Healthcare Provider Details

I. General information

NPI: 1780467514
Provider Name (Legal Business Name): JACQUELYN DEPUYDT DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 ARROWHEAD TRL
CEDAR PARK TX
78613-7806
US

IV. Provider business mailing address

3916 N POTSDAM AVE # 2774
SIOUX FALLS SD
57104-7048
US

V. Phone/Fax

Practice location:
  • Phone: 360-583-0357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCHI-CHI-LIC-7145
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: