Healthcare Provider Details

I. General information

NPI: 1669800942
Provider Name (Legal Business Name): JMJ ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 4TH ST STE. 102
LUBBOCK TX
79416-4900
US

IV. Provider business mailing address

4716 4TH ST STE. 102
LUBBOCK TX
79416-4900
US

V. Phone/Fax

Practice location:
  • Phone: 806-224-0063
  • Fax:
Mailing address:
  • Phone: 806-224-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number11305
License Number StateTX

VIII. Authorized Official

Name: DR. JAMES JOHNSON
Title or Position: CHIROPRACTIC/OWNER
Credential: D.C.
Phone: 806-781-0331