MEDICARE: JOSEAN OMAR JIMENEZ RODRIGUEZ 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	14270	TX

General Provider Information

NPI Number	:	1790310076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEAN OMAR JIMENEZ RODRIGUEZ DC

Provider Business Mailing Address
First Line	:	20312 POPPY HILLS TRL UNIT 4301
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6311
Country	:	US
Telephone Number	:	939-865-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	20312 POPPY HILLS TRL UNIT 4301
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-6311
Country	:	US
Telephone Number	:	939-865-8111
Fax Number	:

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

Provider Enumeration Date	:	03/07/2020
Last Update Date	:	03/07/2020

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