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General NPI Number Information
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NPI Number | 1164646337
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Entity Type | Organization
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Legal Business Name | JETER CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 316 E HOUSE ST
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City | ALVIN
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State | TX
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Zip | 77511-3546
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Country | US
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Telephone | 281-331-4213
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Fax | 281-331-2700
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Provider Business Mailing Address
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Address Line | PO BOX 1385
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City | ALVIN
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State | TX
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Zip | 77512-1385
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Country | US
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Telephone | 281-331-4213
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Fax | 281-331-2700
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Authorized Official
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Title or Position | OWNER
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Name | DR. VINCENT JETER
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Credential | DC
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Telephone | 281-331-4213
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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 | 8141
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License Number State | TX
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