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General NPI Number Information
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NPI Number | 1679934160
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Entity Type | Individual
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Provider Name | JAKE C TIJERINA D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 2601 W LAKE HOUSTON PKWY
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City | KINGWOOD
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State | TX
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Zip | 77339-5222
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Country | US
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Telephone | 210-477-4965
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Fax | 210-468-0682
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Provider Business Mailing Address
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Address Line | 911 CENTRAL PKWY N SUITE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78232-5052
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Country | US
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Telephone | 210-477-4965
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Fax | 210-468-0682
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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 | 13181
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License Number State | TX
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