Provider Demographics
NPI:1821051541
Name:DAY, JERRY EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:EDWARD
Last Name:DAY
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 1:6420 COLLEYVILLE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6466
Mailing Address - Country:US
Mailing Address - Phone:817-980-6642
Mailing Address - Fax:817-251-0136
Practice Address - Street 1:6420 COLLEYVILLE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6466
Practice Address - Country:US
Practice Address - Phone:817-481-8060
Practice Address - Fax:817-251-0136
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605305Medicare ID - Type UnspecifiedMEDICARE ID
TXU58803Medicare UPIN