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General NPI Number Information
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NPI Number | 1154561124
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Entity Type | Organization
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Legal Business Name | JET PERFORMANCE CHIROPRACTIC, PA
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 12402 W 62ND TER
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City | SHAWNEE
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State | KS
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Zip | 66216-1810
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Country | US
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Telephone | 913-766-9266
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Fax | 913-766-9265
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Provider Business Mailing Address
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Address Line | 12402 W 62ND TER
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City | SHAWNEE
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State | KS
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Zip | 66216-1810
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Country | US
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Telephone | 913-766-9266
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Fax | 913-766-9265
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOEL ERRON TERRY
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Credential | D.C.
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Telephone | 913-766-9266
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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 | 01-05209
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License Number State | KS
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