Provider Demographics
NPI:1003350893
Name:ADCOCK CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ADCOCK CHIROPRACTIC PLLC
Other - Org Name:LIFE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-574-4440
Mailing Address - Street 1:5524 OLD JACKSONVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3378
Mailing Address - Country:US
Mailing Address - Phone:903-949-4996
Mailing Address - Fax:
Practice Address - Street 1:5524 OLD JACKSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3378
Practice Address - Country:US
Practice Address - Phone:903-949-4996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX566102Medicare PIN