Provider Demographics
NPI:1871629782
Name:PROSPER CHIROPRACTIC AND WELLNESS P.C.
Entity type:Organization
Organization Name:PROSPER CHIROPRACTIC AND WELLNESS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-347-9933
Mailing Address - Street 1:221 N PRESTON RD
Mailing Address - Street 2:STE D
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8792
Mailing Address - Country:US
Mailing Address - Phone:972-347-9933
Mailing Address - Fax:
Practice Address - Street 1:221 N PRESTON RD
Practice Address - Street 2:STE D
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8792
Practice Address - Country:US
Practice Address - Phone:972-347-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU91167Medicare UPIN
TX00W433Medicare ID - Type Unspecified