1619221082 NPI number — JOHNSON CHIROPRACTIC CENTER, PC

Table of content: DR. CLARENCE BRENT HAEBERLE DMD (NPI 1912072174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619221082 NPI number — JOHNSON CHIROPRACTIC CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON CHIROPRACTIC CENTER, PC
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:
6
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:
1619221082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N. COLLEGIATE
Provider Second Line Business Mailing Address:
#900
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-905-4939
Provider Business Mailing Address Fax Number:
903-905-4940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N. COLLEGIATE
Provider Second Line Business Practice Location Address:
#900
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-905-4939
Provider Business Practice Location Address Fax Number:
903-905-4940
Provider Enumeration Date:
11/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
PRESIDENT/DOCTOR
Authorized Official Telephone Number:
903-905-4939

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  10808 , 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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