Provider Demographics
NPI:1083020713
Name:DENISON CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:DENISON CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-463-5151
Mailing Address - Street 1:1721 S AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-6709
Mailing Address - Country:US
Mailing Address - Phone:903-463-5151
Mailing Address - Fax:903-463-6584
Practice Address - Street 1:1721 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-6709
Practice Address - Country:US
Practice Address - Phone:903-463-5151
Practice Address - Fax:903-463-6584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001149601Medicaid
TX001149601Medicaid