Provider Demographics
NPI:1073739918
Name:REXROAT, KIRK A (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:A
Last Name:REXROAT
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COUNTRY CLUB RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2358
Mailing Address - Country:US
Mailing Address - Phone:940-464-2273
Mailing Address - Fax:940-464-2270
Practice Address - Street 1:100 COUNTRY CLUB RD STE 107
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-2358
Practice Address - Country:US
Practice Address - Phone:940-464-2273
Practice Address - Fax:940-464-2270
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606440OtherBCBSTX PROVIDER #
TX606440OtherBCBSTX PROVIDER #
TX609828Medicare ID - Type UnspecifiedPROVIDER #