Provider Demographics
NPI:1912070954
Name:JOBE, JUSTIN CHRISTOPHER (DC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CHRISTOPHER
Last Name:JOBE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N PRESTON RD
Mailing Address - Street 2:SUITE 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:SUITE 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:972-347-3866
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX491167Medicare UPIN
TX8F2818Medicare ID - Type Unspecified