Provider Demographics
NPI:1861712044
Name:WRIGHT, JERROD (DC)
Entity type:Individual
Prefix:DR
First Name:JERROD
Middle Name:
Last Name:WRIGHT
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 1:321 W SOUTHLAKE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6190
Mailing Address - Country:US
Mailing Address - Phone:817-488-4186
Mailing Address - Fax:
Practice Address - Street 1:500 N CARROLL AVE
Practice Address - Street 2:STE. 100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6410
Practice Address - Country:US
Practice Address - Phone:817-488-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor