Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8580 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 8580 | TX |
NPI | 1225103773 |
---|---|
Provider Name | Dr. Jerry Don Lloyd |
First Address | College Station, TX 77842-2410 |
Second Address | Bryan, TX 77802-2505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 25/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
653066 | BCBS (01) | TX |
8AW120 | BCBS (01) | TX |
U82578 | (02) | TX |