Provider Demographics
NPI:1689003295
Name:JETER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:JETER CHIROPRACTIC PC
Other - Org Name:ALVIN CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:W
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-331-4213
Mailing Address - Street 1:316 E HOUSE ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-3546
Mailing Address - Country:US
Mailing Address - Phone:281-331-4213
Mailing Address - Fax:281-331-2700
Practice Address - Street 1:316 E HOUSE ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-3546
Practice Address - Country:US
Practice Address - Phone:281-331-4213
Practice Address - Fax:281-331-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8141305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00429RMedicare PIN