Provider Demographics
NPI:1093909905
Name:NW MAIN CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:NW MAIN CHIROPRACTIC, P.A.
Other - Org Name:ENNIS CHIROPRACTIC AND WELNESS CENTER, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-875-9377
Mailing Address - Street 1:109 NW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4053
Mailing Address - Country:US
Mailing Address - Phone:972-875-9377
Mailing Address - Fax:972-875-4325
Practice Address - Street 1:109 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4053
Practice Address - Country:US
Practice Address - Phone:972-875-9377
Practice Address - Fax:972-875-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8285111N00000X
TX12144111N00000X
TX1044915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609305Medicare PIN