Provider Demographics
NPI:1154913820
Name:NEVAREZ, JESUS
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:NEVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S DENTON TAP RD STE 410
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5036
Mailing Address - Country:US
Mailing Address - Phone:469-393-0504
Mailing Address - Fax:
Practice Address - Street 1:120 S DENTON TAP RD STE 410
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5036
Practice Address - Country:US
Practice Address - Phone:469-393-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor