1285099291 NPI number — DR. NICOLE SHAIEB JACKSON D.C.

Table of content: DR. NICOLE SHAIEB JACKSON D.C. (NPI 1285099291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285099291 NPI number — DR. NICOLE SHAIEB JACKSON D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
NICOLE
Provider Middle Name:
SHAIEB
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285099291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2840 LEGACY DR
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-6049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-668-9200
Provider Business Mailing Address Fax Number:
972-668-9204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2840 LEGACY DR
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-6049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-668-9200
Provider Business Practice Location Address Fax Number:
972-668-9204
Provider Enumeration Date:
12/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  13060 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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