1295960656 NPI number — PILCHER CHIROPRACTIC CLINIC

Table of content: (NPI 1295960656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295960656 NPI number — PILCHER CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PILCHER CHIROPRACTIC CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1295960656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 TITUS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILMER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75644-1735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-680-2511
Provider Business Mailing Address Fax Number:
903-680-2439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 TITUS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILMER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75644-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-680-2511
Provider Business Practice Location Address Fax Number:
903-680-2439
Provider Enumeration Date:
05/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PILCHR
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-680-2511

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11183 , 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)