Provider Demographics
NPI:1801881172
Name:JETER, VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:JETER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E HOUSE ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-3546
Mailing Address - Country:US
Mailing Address - Phone:281-331-4213
Mailing Address - Fax:
Practice Address - Street 1:316 E HOUSE ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-3546
Practice Address - Country:US
Practice Address - Phone:281-331-4213
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89640YOtherBLUE CROSS BLUE SHEILD
TX8926M0Medicare ID - Type UnspecifiedMEDICARE