Healthcare Provider Details

I. General information

NPI: 1962773796
Provider Name (Legal Business Name): JAMI WEST D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KIOWA DR W SUITE 301
LAKE KIOWA TX
76240-9584
US

IV. Provider business mailing address

100 KIOWA DR W SUITE 301
LAKE KIOWA TX
76240-9584
US

V. Phone/Fax

Practice location:
  • Phone: 940-668-8755
  • Fax: 940-222-6742
Mailing address:
  • Phone: 940-668-8755
  • Fax: 940-222-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: