Individual
DR. JACK ALEXANDER MUSTARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3501 SONCY, SUITE 2, AMARILLO, TX 79121
(806) 351-2708
(806) 351-2349
Mailing address
3501 SONCY, SUITE 2, AMARILLO, TX 79121
(806) 351-2708
(806) 351-2349
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
9759
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
608055
BLUE CROSS BLUE SHIELD
TX
01
—
8D1477
MEDICARE
TX
Enumeration date
11/07/2006
Last updated
07/09/2007
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