Healthcare Provider Details

I. General information

NPI: 1811744972
Provider Name (Legal Business Name): JILLIAN KAY ROVETTI DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W AIRPORT FWY STE 800
IRVING TX
75062-6207
US

IV. Provider business mailing address

1309 MAIN ST APT 1209
DALLAS TX
75202-4086
US

V. Phone/Fax

Practice location:
  • Phone: 972-392-3400
  • Fax:
Mailing address:
  • Phone: 775-771-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16006
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: