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General NPI Number Information
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NPI Number | 1134884257
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Entity Type | Individual
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Provider Name | JAMES OLIVER JACQUES DC
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Gender | Male
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 807 E 4TH ST UNIT 9
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City | AUSTIN
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State | TX
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Zip | 78702-3828
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Country | US
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Telephone | 518-944-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 807 E 4TH ST UNIT 1
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City | AUSTIN
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State | TX
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Zip | 78702-3828
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Country | US
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Telephone | 518-944-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 14204
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License Number State | TX
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