Provider Demographics
NPI:1790310076
Name:JIMENEZ RODRIGUEZ, JOSEAN OMAR (DC)
Entity Type:Individual
Prefix:
First Name:JOSEAN
Middle Name:OMAR
Last Name:JIMENEZ RODRIGUEZ
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 1:20312 POPPY HILLS TRL UNIT 4301
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6311
Mailing Address - Country:US
Mailing Address - Phone:939-865-8111
Mailing Address - Fax:
Practice Address - Street 1:20312 POPPY HILLS TRL UNIT 4301
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6311
Practice Address - Country:US
Practice Address - Phone:939-865-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor