MEDICARE: WILLIAM JEFFREY POOL D.O.

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	10028	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB149673	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1659462141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JEFFREY POOL D.O.

Provider Business Mailing Address
First Line	:	611 N BROADWAY ST
Second Line	:
City	:	JOSHUA
State	:	TX
Zip	:	76058-6155
Country	:	US
Telephone Number	:	817-484-2707
Fax Number	:	817-484-2706

Provider Business Practice Location Address
First Line	:	611 N BROADWAY ST
Second Line	:
City	:	JOSHUA
State	:	TX
Zip	:	76058-6155
Country	:	US
Telephone Number	:	817-484-2707
Fax Number	:	817-484-2706

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	04/18/2016

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Directions to “ WILLIAM JEFFREY POOL D.O.” Practice Location

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