1417148701 NPI number — ISDALE CORRECTIVE CHIROPRACTIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417148701 NPI number — ISDALE CORRECTIVE CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISDALE CORRECTIVE CHIROPRACTIC
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:
ISDALE CHIROPRACTIC
Provider Other Organization Name Type Code:
5
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:
1417148701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
716 INDIAN TRL STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARKER HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76548-5702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-698-1600
Provider Business Mailing Address Fax Number:
254-698-1605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 INDIAN TRL STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARKER HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76548-5702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-698-1600
Provider Business Practice Location Address Fax Number:
254-698-1605
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ISDALE
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
254-699-4004

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2385 , 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)





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