Provider Demographics
NPI:1134773815
Name:BARTLETT, JAY R (DAOM, DCCM, MACOM)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:R
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:DAOM, DCCM, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25839 BIG BLUESTEM
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2831
Mailing Address - Country:US
Mailing Address - Phone:512-971-8686
Mailing Address - Fax:
Practice Address - Street 1:24405 WILDERNESS OAK BLDG E
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7874
Practice Address - Country:US
Practice Address - Phone:512-971-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist