1902153976 NPI number — LONGACRE CHIROPRACTIC

Table of content: (NPI 1902153976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902153976 NPI number — LONGACRE CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONGACRE 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:
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:
1902153976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 S ELM ST
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76201-6050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-549-1810
Provider Business Mailing Address Fax Number:
469-533-0383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 S ELM ST
Provider Second Line Business Practice Location Address:
#101
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76201-6050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-549-1810
Provider Business Practice Location Address Fax Number:
469-533-0383
Provider Enumeration Date:
08/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LONGACRE
Authorized Official First Name:
MICHEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
469-549-1810

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8967 , 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)





Copyright © 2007-2025 www.npivalidator.com