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NPI Code Detail

MEDICARE: DR. JORGE LUIS NIETO D.C.

MEDICARE: DR. JORGE LUIS NIETO 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
1111N00000XChiropractor10219TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18AM291OTHERTXBCBS OF TEXAS
27476907OTHERTXAETNA

General Provider Information

NPI Number : 1790794865
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORGE LUIS NIETO D.C.
Provider Business Mailing Address
First Line : 1003 CALGARY CT
Second Line :
City : LEWISVILLE
State : TX
Zip : 75077-2953
Country : US
Telephone Number : 469-353-4364
Fax Number :
Provider Business Practice Location Address
First Line : 6101 WINDHAVEN PKWY STE 145
Second Line :
City : PLANO
State : TX
Zip : 75093-8198
Country : US
Telephone Number : 972-473-8980
Fax Number : 972-212-6851
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2006
Last Update Date : 02/26/2021

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