Provider Demographics
NPI:1508555129
Name:EZEANI, JUSTICE CHUKWUEMEKA (DC)
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:CHUKWUEMEKA
Last Name:EZEANI
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 1:9840 N MACARTHUR BLVD APT 1905
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4713
Mailing Address - Country:US
Mailing Address - Phone:512-636-9856
Mailing Address - Fax:
Practice Address - Street 1:4051 LYNDON B JOHNSON FWY STE 190
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5710
Practice Address - Country:US
Practice Address - Phone:469-264-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor