Provider Demographics
NPI:1083730253
Name:JACQUELYN F. COLE, DC, PC
Entity Type:Organization
Organization Name:JACQUELYN F. COLE, DC, PC
Other - Org Name:COLE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:FERGUSON
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-937-1215
Mailing Address - Street 1:2025 FLOUR BLUFF DR.
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-5309
Mailing Address - Country:US
Mailing Address - Phone:361-937-1215
Mailing Address - Fax:361-939-7382
Practice Address - Street 1:2025 FLOUR BLUFF DR.
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5309
Practice Address - Country:US
Practice Address - Phone:361-937-1215
Practice Address - Fax:361-939-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4437111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT84764Medicare UPIN
TX603032Medicare ID - Type Unspecified