Jesus Marcial, DC
Individual provider Active NPI Chiropractor · Ennis, TX
NPI 1407857915 · NPPES record last updated Feb 13, 2020
Key facts
- NPI
- 1407857915
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 9980 (TX)
- Practice address
- 2200 W Ennis Ave
Suite a
Ennis, TX 75119-8054 - Phone
- (972) 875-8676
- Fax
- (972) 875-8481
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2200 W Ennis Ave
Suite a
Ennis, TX 75119-8005
Phone (972) 875-8676
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060224000109 | TX | Practitioner - Chiropractic | 3072529320 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9980 | TX | MD | Behavioral Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hometown Chiropractic, PLLC | Chiropractor | Current |
Accepting new patients |
| Marcial & Mazaheri LLC | Chiropractor | Current | Accepting new patients |
| Grapevine Health | Chiropractor | Current | Accepting new patients |
| Angleton Chiropractic & Rehab, PLLC | Chiropractor | Past |
Accepting new patients |
| Hometown Physical Medicine, PLLC | Past | Accepting new patients |
Locations
2200 W Ennis Ave
Ste A
Ennis, TX 75119
Phone (972) 875-8600
112 S McKinney St
Ennis, TX 75119
Phone (972) 875-8600
607 Ferris Ave
Waxahachie, TX 75165
Phone (972) 923-1003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 9980 | TX | Yes |
Addresses
Primary practice location
2200 W Ennis Ave
Suite a
Ennis, TX 75119-8054
Mailing address
2200 W Ennis Ave
Suite a
Ennis, TX 75119-8054
Phone (972) 875-8676
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9380653 | Other | TX | PHCS PROVIDER ID |
| 186463901 | Medicaid | TX | |
| 608125 | Other | TX | BLUE CROSS PROVIDER ID |
Other providers in Ennis, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.