Provider Demographics
NPI:1891198263
Name:CHAMBLESS, JARED DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:DAVID
Last Name:CHAMBLESS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 75TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2523
Mailing Address - Country:US
Mailing Address - Phone:806-797-4000
Mailing Address - Fax:806-771-3659
Practice Address - Street 1:5224 75TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2523
Practice Address - Country:US
Practice Address - Phone:806-797-4000
Practice Address - Fax:806-771-3659
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX12749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378878AL9VOtherMEDICARE