Provider Demographics
NPI:1073621223
Name:ISDALE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ISDALE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-699-4004
Mailing Address - Street 1:1201 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6108
Mailing Address - Country:US
Mailing Address - Phone:254-699-4004
Mailing Address - Fax:254-699-4056
Practice Address - Street 1:1201 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6108
Practice Address - Country:US
Practice Address - Phone:254-699-4004
Practice Address - Fax:254-699-4056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty