Organization
JACK A PEDERSEN HURST CHIROPRACTIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK A PEDERSEN D.C. (OWNER)
(817) 251-7328
Entity
Organization
Contact information
Practice address
7155 COLLEYVILLE BLVD, STE 103, COLLEYVILLE, TX 76034-8003
(817) 251-7328
(817) 421-7380
Mailing address
7155 COLLEYVILLE BLVD, STE 103, COLLEYVILLE, TX 76034-8003
(817) 251-7328
(817) 421-7380
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2471
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00F40Y
BLUE CROSS GROUP ID
TX
01
—
1164484895
INDIVIDUAL NPI #
TX
01
—
80K571
BLUE CROSS INDIVIDUAL ID
TX
Enumeration date
10/26/2007
Last updated
01/05/2015
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