1326141201 NPI number — HEALTHCARE CHIROPRACTIC & REHABILITATION CLINIC

Table of content: (NPI 1326141201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326141201 NPI number — HEALTHCARE CHIROPRACTIC & REHABILITATION CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE CHIROPRACTIC & REHABILITATION 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:
1326141201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3020 E HEBRON PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010-4457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-820-0425
Provider Business Mailing Address Fax Number:
972-662-4411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 OLD DENTON RD STE 184
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75007-5187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-483-3300
Provider Business Practice Location Address Fax Number:
214-483-3401
Provider Enumeration Date:
09/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEDFORD
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
214-483-3300

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9141 , 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)

  • Identifier: 9141 . This is a "CHIROPRACTIC LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".