Provider Demographics
NPI:1043318413
Name:TOWN CENTER CHIROPRACTIC
Entity Type:Organization
Organization Name:TOWN CENTER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEGANEHJOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-906-7988
Mailing Address - Street 1:2717 CROSS TIMBERS RD
Mailing Address - Street 2:STE 418
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-906-7988
Mailing Address - Fax:972-906-7989
Practice Address - Street 1:2717 CROSS TIMBERS RD
Practice Address - Street 2:STE 418
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-906-7988
Practice Address - Fax:972-906-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0082NPOtherBLUE CROSS BLUE SHIELD