Provider Demographics
NPI:1306052303
Name:ACHTERBERG, JEAN (DC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:ACHTERBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 LYNDON B JOHNSON FWY STE 122
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7773
Mailing Address - Country:US
Mailing Address - Phone:972-406-8786
Mailing Address - Fax:
Practice Address - Street 1:3003 LYNDON B JOHNSON FWY STE 122
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7773
Practice Address - Country:US
Practice Address - Phone:972-406-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
605779OtherBLUE CROSS BLUE SHIELD
605779OtherBLUE CROSS BLUE SHIELD
609153Medicare ID - Type Unspecified