Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11340 | TX |
NPI | 1003145269 |
---|---|
Provider Name | Mr. Jason Meyer |
First Address | Fort Worth, TX 76108-0777 |
Second Address | Fort Worth, TX 76102-3421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2009 |
Last Update Date | 17/12/2009 |