Provider Demographics
NPI:1003876830
Name:HEMBREE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:HEMBREE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMBREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-561-0086
Mailing Address - Street 1:1904 WEST GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4406
Mailing Address - Country:US
Mailing Address - Phone:903-561-0086
Mailing Address - Fax:903-561-2576
Practice Address - Street 1:1904 WEST GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4406
Practice Address - Country:US
Practice Address - Phone:903-561-0086
Practice Address - Fax:903-561-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057MDOtherBLUE CROSS GROUP ID
TX173052501Medicaid
TX00242YMedicare PIN