Healthcare Provider Details

I. General information

NPI: 1538348305
Provider Name (Legal Business Name): JENNIFER DOUGLIN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E CLARENDON DR
DALLAS TX
75203-2914
US

IV. Provider business mailing address

211 E CLARENDON DR
DALLAS TX
75203-2914
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-4903
  • Fax: 206-309-0883
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number6988
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number6988
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number6988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: