Provider Demographics
NPI:1275838120
Name:SQUYRES, JASON CODY (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:CODY
Last Name:SQUYRES
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 1:15080 HWY 156
Mailing Address - Street 2:SUITE C
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247
Mailing Address - Country:US
Mailing Address - Phone:940-242-6641
Mailing Address - Fax:940-242-6642
Practice Address - Street 1:15080 HWY 156
Practice Address - Street 2:SUITE C
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247
Practice Address - Country:US
Practice Address - Phone:940-242-6641
Practice Address - Fax:940-242-6642
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128312Medicare PIN