Provider Demographics
NPI:1225062540
Name:JAILLET, PETER DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
Last Name:JAILLET
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 1:3610 N JOSEY LN STE 130
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3143
Mailing Address - Country:US
Mailing Address - Phone:972-395-9795
Mailing Address - Fax:972-395-1998
Practice Address - Street 1:3610 N JOSEY LN STE 130
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-3143
Practice Address - Country:US
Practice Address - Phone:972-395-9795
Practice Address - Fax:972-395-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6689111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C6855Medicare ID - Type Unspecified