Provider Demographics
NPI:1679934160
Name:TIJERINA, JAKE C (DC)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:C
Last Name:TIJERINA
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 1:911 CENTRAL PKWY N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5052
Mailing Address - Country:US
Mailing Address - Phone:210-477-4965
Mailing Address - Fax:210-468-0682
Practice Address - Street 1:2601 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5222
Practice Address - Country:US
Practice Address - Phone:210-477-4965
Practice Address - Fax:210-468-0682
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor