Provider Demographics
NPI:1700281003
Name:PLENTL, JILL MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:PLENTL
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 1:831 N ATKERSON LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4707
Mailing Address - Country:US
Mailing Address - Phone:817-223-0759
Mailing Address - Fax:817-656-4761
Practice Address - Street 1:781 LONESOME DOVE TRL
Practice Address - Street 2:STE B
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-6018
Practice Address - Country:US
Practice Address - Phone:817-656-4760
Practice Address - Fax:817-656-4761
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor