Individual provider Active NPI

Jenny Lynn Marchuk, NMD, LAC

  • Family Medicine Physician
  • Dallas, TX
National Provider Identifier
1437810892
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
IPHMNC3256 Issued in TX
Practice address
17480 Dallas Pkwy Ste 212
Dallas, TX 75287-7362
Phone
(469) 617-8229
Fax
(915) 201-1658
NPI assigned
Jan 6, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X IPHMNC3256 TX
Nutrition ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NN1001X IPHMNM8919 TX
Basic Emergency Medical TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 146N00000X 67F29 TX
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X IPHMNC3256
NaturopathGroup: 193200000X MULTI-SPECIALTY GROUP 175F00000X TX
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204C00000X IPHMNM8919 TX
Allergy PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207KA0200X IPHMNC3256 TX
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X IPHMNC3256 TX
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X IPHMNC3256 TX
Critical Care Medicine (Obstetrics & Gynecology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VC0200X CC38FF9D6453 TX
Neuromuscular Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0008X IPHMNC3256 TX
Rehabilitation PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 225400000X IPHMNM8919
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X TX
KinesiotherapistGroup: 193200000X MULTI-SPECIALTY GROUP 226300000X TX
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X IPHMNC3256 TX Primary

Addresses

Primary practice location

17480 Dallas Pkwy Ste 212
Dallas, TX 75287-7362

Mailing address

17480 Dallas Pkwy Ste 212
Dallas, TX 75287-7362
Phone (682) 704-7842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
IPHMNM8919TXMDNutrition Chiropractor
67F29TXMDBasic Emergency Medical Technician
IPHMNC3256TXMDGeriatric Medicine (Family Medicine) Physician
CC38FF9D6453TXMDCritical Care Medicine (Obstetrics & Gynecology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Health and Wellness of Texas Acupuncturist CurrentSince Apr 23, 2023 Accepting new patients

Locations

17480 Dallas Pkwy
Ste 212
Dallas, TX 75287
Phone (469) 617-8229

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1437810892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17480 DALLAS PKWY STE 212",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752877362",
            "telephone_number": "682-704-7842",
            "fax_number": "915-201-1658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17480 DALLAS PKWY STE 212",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752877362",
            "telephone_number": "469-617-8229",
            "fax_number": "915-201-1658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCHUK",
        "first_name": "JENNY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "NMD, LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-06",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "IPHMNC3256",
            "primary": false
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": "TX",
            "license": "IPHMNM8919",
            "primary": false
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Basic",
            "state": "TX",
            "license": "67F29",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": "IPHMNC3256",
            "primary": false
        },
        {
            "code": "175F00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Naturopath",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "204C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "TX",
            "license": "IPHMNM8919",
            "primary": false
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Allergy",
            "state": "TX",
            "license": "IPHMNC3256",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "TX",
            "license": "IPHMNC3256",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "IPHMNC3256",
            "primary": false
        },
        {
            "code": "207VC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Critical Care Medicine",
            "state": "TX",
            "license": "CC38FF9D6453",
            "primary": false
        },
        {
            "code": "2084N0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "TX",
            "license": "IPHMNC3256",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": "IPHMNM8919",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "226300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Kinesiotherapist",
            "state": "TX",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "IPHMNC3256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.