Provider Demographics
NPI:1780124016
Name:PRICE, JAKE EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:JAKE
Middle Name:EDWARD
Last Name:PRICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14019 SOUTHWEST FWY
Mailing Address - Street 2:310
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3563
Mailing Address - Country:US
Mailing Address - Phone:832-886-4054
Mailing Address - Fax:832-886-4071
Practice Address - Street 1:14019 SOUTHWEST FWY
Practice Address - Street 2:310
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3563
Practice Address - Country:US
Practice Address - Phone:832-886-4054
Practice Address - Fax:832-886-4071
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor