Provider Demographics
NPI:1205415742
Name:ISDALE, JAZMIN (DC)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:ISDALE
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 1:4207 ADAGIO PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1689
Mailing Address - Country:US
Mailing Address - Phone:530-966-2557
Mailing Address - Fax:
Practice Address - Street 1:4207 ADAGIO PL
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1689
Practice Address - Country:US
Practice Address - Phone:530-966-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14655111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor