Healthcare Provider Details

I. General information

NPI: 1619256633
Provider Name (Legal Business Name): JONATHAN C EVERETT D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19510 KUYKENDAHL RD SUITE A
SPRING TX
77379-3481
US

IV. Provider business mailing address

19510 KUYKENDAHL RD SUITE A
SPRING TX
77379-3481
US

V. Phone/Fax

Practice location:
  • Phone: 281-651-7111
  • Fax: 281-288-9550
Mailing address:
  • Phone: 281-651-7111
  • Fax: 281-288-9550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11673
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: