Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 15044 | TX |
N | 111NN0400X | Neurology | 15044 | TX |
N | 111NN1001X | Nutrition | 15044 | TX |
N | 111NP0017X | Pediatric Chiropractor | 15044 | TX |
NPI | 1205580594 |
---|---|
Provider Name | Dr. Jessica Jean Faulkenberry |
First Address | Fort Worth, TX 76244-9689 |
Second Address | Fort Worth, TX 76244-9689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2022 |
Last Update Date | 07/02/2022 |