Provider Demographics
NPI:1316038821
Name:SILVA, JOSE DE JESUS (DC)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DE JESUS
Last Name:SILVA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 N WALNUT CREEK DR
Mailing Address - Street 2:#2018
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1580
Mailing Address - Country:US
Mailing Address - Phone:817-453-5500
Mailing Address - Fax:817-453-5501
Practice Address - Street 1:990 N WALNUT CREEK DR
Practice Address - Street 2:#2018
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1580
Practice Address - Country:US
Practice Address - Phone:817-453-5500
Practice Address - Fax:817-453-5501
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U89638Medicare UPIN
609724Medicare ID - Type Unspecified