Provider Demographics
NPI:1003389677
Name:NEWLEAF CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:NEWLEAF CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-648-3103
Mailing Address - Street 1:1101 HUTCHINGS ST
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-2425
Mailing Address - Country:US
Mailing Address - Phone:325-648-3103
Mailing Address - Fax:
Practice Address - Street 1:1101 HUTCHINGS ST
Practice Address - Street 2:
Practice Address - City:GOLDTHWAITE
Practice Address - State:TX
Practice Address - Zip Code:76844-2425
Practice Address - Country:US
Practice Address - Phone:325-648-3103
Practice Address - Fax:325-648-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty