Provider Demographics
NPI:1831394972
Name:MEDINA, JESUS TOMAS JR (DC)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:TOMAS
Last Name:MEDINA
Suffix:JR
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 1:1111 N 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4307
Mailing Address - Country:US
Mailing Address - Phone:956-682-4339
Mailing Address - Fax:956-682-4336
Practice Address - Street 1:1111 N 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4307
Practice Address - Country:US
Practice Address - Phone:956-682-4339
Practice Address - Fax:956-682-4336
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor