Provider Demographics
NPI:1679296750
Name:INDEPENDENCE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:INDEPENDENCE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JARQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-626-0309
Mailing Address - Street 1:3248 S PRESTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009-3875
Mailing Address - Country:US
Mailing Address - Phone:214-851-0000
Mailing Address - Fax:214-851-0005
Practice Address - Street 1:3248 S PRESTON RD STE 120
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3875
Practice Address - Country:US
Practice Address - Phone:214-851-0000
Practice Address - Fax:214-851-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty