Provider Demographics
NPI:1437810892
Name:MARCHUK, JENNY LYNN (NMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:LYNN
Last Name:MARCHUK
Suffix:
Gender:F
Credentials:NMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17480 DALLAS PKWY STE 212
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7362
Mailing Address - Country:US
Mailing Address - Phone:682-704-7842
Mailing Address - Fax:915-201-1658
Practice Address - Street 1:17480 DALLAS PKWY STE 212
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7362
Practice Address - Country:US
Practice Address - Phone:469-617-8229
Practice Address - Fax:915-201-1658
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXIPHMNC3256103G00000X, 207KA0200X, 207N00000X, 207QG0300X, 2084N0008X, 207Q00000X
TXIPHMNM8919111NN1001X, 204C00000X
TX67F29146N00000X
IPHMNC3256171100000X
TX175F00000X, 225700000X, 226300000X
TXCC38FF9D6453207VC0200X
IPHMNM8919225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care MedicineGroup - Multi-Specialty
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapistGroup - Multi-Specialty