Provider Demographics
NPI:1255713673
Name:NORBERT, JEANNIQUE (DC)
Entity type:Individual
Prefix:
First Name:JEANNIQUE
Middle Name:
Last Name:NORBERT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 PIPIT CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4330
Mailing Address - Country:US
Mailing Address - Phone:214-697-0515
Mailing Address - Fax:
Practice Address - Street 1:1202 LAKEWAY DR
Practice Address - Street 2:SUITE 14
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4473
Practice Address - Country:US
Practice Address - Phone:214-697-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12966111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor