Provider Demographics
NPI:1285820035
Name:WAYLON JETER, DC
Entity type:Organization
Organization Name:WAYLON JETER, DC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYLON
Authorized Official - Middle Name:
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-394-4040
Mailing Address - Street 1:1060 W FRANKFORD RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-4999
Mailing Address - Country:US
Mailing Address - Phone:972-394-4040
Mailing Address - Fax:972-394-4802
Practice Address - Street 1:1060 W FRANKFORD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-4999
Practice Address - Country:US
Practice Address - Phone:972-394-4040
Practice Address - Fax:972-394-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX603718Medicare PIN