1982734851 NPI number — A CHIROPRACTOR ON HWY 155, INC

Table of content: (NPI 1982734851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982734851 NPI number — A CHIROPRACTOR ON HWY 155, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A CHIROPRACTOR ON HWY 155, INC
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:
R. COLEMAN GRAY, D.C.
Provider Other Organization Name Type Code:
3
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:
1982734851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75802-0950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-729-3772
Provider Business Mailing Address Fax Number:
903-723-0920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 STATE HIGHWAY 155
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75803-8606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-729-3772
Provider Business Practice Location Address Fax Number:
903-723-0920
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
COLEMAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-729-3772

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8293 , 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: 1750372009 . This is a "PROVIDER'S NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com