Provider Demographics
NPI:1033449343
Name:FORT WORTH FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:FORT WORTH FAMILY CHIROPRACTIC
Other - Org Name:FORT WORTH FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:ARLLEN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-737-3922
Mailing Address - Street 1:4936 BYERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4149
Mailing Address - Country:US
Mailing Address - Phone:817-737-3922
Mailing Address - Fax:817-737-3929
Practice Address - Street 1:4936 BYERS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4149
Practice Address - Country:US
Practice Address - Phone:817-737-3922
Practice Address - Fax:817-737-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty