Provider Demographics
NPI:1033397377
Name:COGGINS CHIROPRACTIC
Entity Type:Organization
Organization Name:COGGINS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AUDIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DCFIACA
Authorized Official - Phone:432-837-5070
Mailing Address - Street 1:906 E. AVE. B
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79830
Mailing Address - Country:US
Mailing Address - Phone:432-837-5070
Mailing Address - Fax:432-837-3203
Practice Address - Street 1:906 E AVENUE B
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-3812
Practice Address - Country:US
Practice Address - Phone:432-837-5070
Practice Address - Fax:432-837-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605398OtherBLUE CROSS BLUE SHIELD
TX608136OtherBLUE CROSS BLUE SHIELD
TX608136Medicare PIN
TX605398Medicare PIN