Provider Demographics
NPI:1760531024
Name:POWELL, JENNIFER LYNN (CNIM, DABNM, DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:POWELL
Suffix:
Gender:F
Credentials:CNIM, DABNM, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14983 BOAZ LN
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-4801
Mailing Address - Country:US
Mailing Address - Phone:972-786-6167
Mailing Address - Fax:903-882-7748
Practice Address - Street 1:14983 BOAZ LN
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-4801
Practice Address - Country:US
Practice Address - Phone:972-786-6167
Practice Address - Fax:903-882-7748
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10078111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV06829Medicare UPIN
TX611978Medicare ID - Type Unspecified