Weaver, Jackie Lynn

Weaver, Jackie Lynn is an sole proprietor health care provider with primary practice located at 2726 W Gentry Pkwy , Tyler TX 75702-1635. He recently has 2 registered licenses in different health care specialties including Chiropractic Providers / Chiropractor, Pharmacy Service Providers / Pharmacist. Chiropractic Providers / Chiropractor is his primary health care specialty. Weaver, Jackie Lynn can be contacted via phone (903) 593-2533.

Contact Information

Primary practice address
2726 W Gentry Pkwy Tyler TX 75702-1635
Phone: (903) 593-2533
Fax: (903) 593-2555
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 6129 DC Texas
Pharmacy Service Providers / Pharmacist 183500000X 48560 Texas

Profile Details

NPI number 1720072523
LBN Legal business name Weaver, Jackie Lynn
Credentials DC, PHARM D
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 7th, 2005
Last updated Jan 19th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720072523 NPPES
Texas MEDICAID 001665101
Texas Other 8K1680

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