Provider Demographics
NPI:1114492709
Name:ALEDO TEXAS FAMILY CHIROPRACTIC LLC DBA TEXAS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ALEDO TEXAS FAMILY CHIROPRACTIC LLC DBA TEXAS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PROCTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-441-2810
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-0189
Mailing Address - Country:US
Mailing Address - Phone:817-441-2810
Mailing Address - Fax:817-441-2811
Practice Address - Street 1:213 OLD ANNETTA RD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4455
Practice Address - Country:US
Practice Address - Phone:817-441-2810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780785584OtherINDIVIDUAL NPI
TX7555364OtherAETNA