Provider Demographics
NPI:1356503072
Name:BEIGHTS, JENNIFER NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICOLE
Last Name:BEIGHTS
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 1:181 GRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7631
Mailing Address - Country:US
Mailing Address - Phone:817-488-4466
Mailing Address - Fax:
Practice Address - Street 1:181 GRAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7631
Practice Address - Country:US
Practice Address - Phone:817-488-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor