Provider Demographics
NPI:1801949177
Name:DUVALL, JERRY WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WAYNE
Last Name:DUVALL
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 1:1514 S 77 SUNSHINESTRIP
Mailing Address - Street 2:SUITE 19
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7208
Mailing Address - Country:US
Mailing Address - Phone:956-425-6932
Mailing Address - Fax:956-425-6933
Practice Address - Street 1:1514 S 77 SUNSHINESTRIP
Practice Address - Street 2:SUITE 19
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7208
Practice Address - Country:US
Practice Address - Phone:956-425-6932
Practice Address - Fax:956-425-6933
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5960111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605139Medicaid
TX605139Medicare ID - Type Unspecified
TX605139Medicaid