Provider Demographics
NPI:1346015153
Name:ACOSTA, JASMINE RAE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:RAE
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13617 INWOOD RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4629
Mailing Address - Country:US
Mailing Address - Phone:214-774-9500
Mailing Address - Fax:
Practice Address - Street 1:13617 INWOOD RD STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4629
Practice Address - Country:US
Practice Address - Phone:214-774-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor