Provider Demographics
NPI:1093952541
Name:MABANK CHIROPRACTIC
Entity Type:Organization
Organization Name:MABANK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-887-6882
Mailing Address - Street 1:1204 S 3RD ST
Mailing Address - Street 2:STE 102
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-7679
Mailing Address - Country:US
Mailing Address - Phone:903-887-6882
Mailing Address - Fax:903-887-3868
Practice Address - Street 1:1204 S 3RD ST
Practice Address - Street 2:STE 102
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-7679
Practice Address - Country:US
Practice Address - Phone:903-887-6882
Practice Address - Fax:903-887-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU61226Medicare UPIN