Provider Demographics
NPI:1104837756
Name:MAGNOLIA CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:MAGNOLIA CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-557-2982
Mailing Address - Street 1:139 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-2926
Mailing Address - Country:US
Mailing Address - Phone:972-554-1511
Mailing Address - Fax:972-554-1513
Practice Address - Street 1:139 S MAIN ST
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-2926
Practice Address - Country:US
Practice Address - Phone:972-554-1511
Practice Address - Fax:972-554-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty