Provider Demographics
NPI:1972912731
Name:LONGORIA, JILLIAN
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:BLAIRE
Other - Last Name:LONGORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12155 JONES RD STE A
Mailing Address - Street 2:APT 434
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5281
Mailing Address - Country:US
Mailing Address - Phone:281-890-5599
Mailing Address - Fax:281-890-7067
Practice Address - Street 1:12155 JONES RD STE A
Practice Address - Street 2:APT 434
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5281
Practice Address - Country:US
Practice Address - Phone:281-890-5599
Practice Address - Fax:281-890-7067
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor