MEDICARE: DR. JENNELLE L SWEENEY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	11441	TX
2	111NI0900X	Internist Chiropractor	11441	TX
3	111NN0400X	Neurology Chiropractor	11441	TX
4	111NN1001X	Nutrition Chiropractor	11441	TX

General Provider Information

NPI Number	:	1013233956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNELLE L SWEENEY DC

Provider Business Mailing Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE 204
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-340-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1931 NW MILITARY HWY
Second Line	:	SUITE 204
City	:	CASTLE HILLS
State	:	TX
Zip	:	78213-2153
Country	:	US
Telephone Number	:	210-340-2150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	09/16/2014

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