Healthcare Provider Details

I. General information

NPI: 1780835538
Provider Name (Legal Business Name): JENNIFER S PAINTER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MAIN ST STE 150
LAKE DALLAS TX
75065-3729
US

IV. Provider business mailing address

5121 GRADY CT
FLOWER MOUND TX
75028-1028
US

V. Phone/Fax

Practice location:
  • Phone: 307-343-0603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3911
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number14554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: