Healthcare Provider Details

I. General information

NPI: 1437387974
Provider Name (Legal Business Name): WATERS FAMILY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 BELT LINE RD SUITE 350
DALLAS TX
75254-8145
US

IV. Provider business mailing address

7920 BELT LINE RD SUITE 350
DALLAS TX
75254-8145
US

V. Phone/Fax

Practice location:
  • Phone: 972-733-4120
  • Fax: 972-861-5067
Mailing address:
  • Phone: 972-733-4120
  • Fax: 972-861-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JAROD KEITH WATERS
Title or Position: OWNER/CEO
Credential: DC
Phone: 972-733-4120