Provider Demographics
NPI:1689863433
Name:DOVAL, JACQUELINE ANNETTE (DC)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:ANNETTE
Last Name:DOVAL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WESTHEIMER
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-3030
Mailing Address - Country:US
Mailing Address - Phone:713-627-9355
Mailing Address - Fax:713-807-1220
Practice Address - Street 1:404 WESTHEIMER
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3030
Practice Address - Country:US
Practice Address - Phone:713-627-9355
Practice Address - Fax:713-807-1220
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6059111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX604057Medicare PIN