Healthcare Provider Details

I. General information

NPI: 1972912731
Provider Name (Legal Business Name): JILLIAN LONGORIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN BLAIRE LONGORIA DC

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12155 JONES RD STE A APT 434
HOUSTON TX
77070-5281
US

IV. Provider business mailing address

12155 JONES RD STE A APT 434
HOUSTON TX
77070-5281
US

V. Phone/Fax

Practice location:
  • Phone: 281-890-5599
  • Fax: 281-890-7067
Mailing address:
  • Phone: 281-890-5599
  • Fax: 281-890-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: