1689959496 NPI number — THE CHIROPRACTIC PLACE, P.A.

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 1689959496 NPI number — THE CHIROPRACTIC PLACE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHIROPRACTIC PLACE, P.A.
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:
1689959496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76472-0064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-214-0408
Provider Business Mailing Address Fax Number:
817-441-2811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 OLD ANNETTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76008-4455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-214-0408
Provider Business Practice Location Address Fax Number:
817-441-2811
Provider Enumeration Date:
10/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
682-214-0408

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  11690 , 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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