Provider Demographics
NPI:1578534319
Name:COATS, JESSE T (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:T
Last Name:COATS
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 1:1346 BROADWAY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-6482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:281-996-6988
Practice Address - Street 1:1346 BROADWAY ST STE 110
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-6482
Practice Address - Country:US
Practice Address - Phone:281-996-7600
Practice Address - Fax:281-996-6988
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6279111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06040818Medicaid
TX605285Medicare ID - Type Unspecified
TXC06040818Medicaid