MEDICARE: DR. JACQUELINE GROOMS D.C.

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	11330	TX

General Provider Information

NPI Number	:	1235459991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE GROOMS D.C.

Provider Business Mailing Address
First Line	:	2300 MCDERMOTT RD
Second Line	:	SUITE 200-371
City	:	PLANO
State	:	TX
Zip	:	75025-7016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 VIRGINIA PKWY
Second Line	:	SUITE 100
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4917
Country	:	US
Telephone Number	:	972-542-3300
Fax Number	:

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

Provider Enumeration Date	:	06/04/2010
Last Update Date	:	06/04/2010

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