=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871629782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROSPER CHIROPRACTIC AND WELLNESS P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 N PRESTON RD STE D
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-8792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-347-9933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 221 N PRESTON RD STE D
-----------------------------------------------------
City | PROSPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75078-8792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-347-9933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | JUSTIN CHRISTOPHER JOBE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 972-347-9933
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9168
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------