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General NPI Number Information
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NPI Number | 1255662029
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Entity Type | Organization
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Legal Business Name | PERSISTENT HEALTH PA
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 4110 FM 407 STE 200
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City | LEWISVILLE
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State | TX
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Zip | 75077-7269
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Country | US
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Telephone | 940-455-2122
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Fax | 940-455-7359
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Provider Business Mailing Address
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Address Line | 4110 FM 407 STE 200
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City | LEWISVILLE
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State | TX
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Zip | 75077-7269
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Country | US
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Telephone | 940-455-2122
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Fax | 940-455-7359
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | JURE MARENIC
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Credential | DC
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Telephone | 940-455-2122
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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 | 9028
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License Number State | TX
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