Provider Demographics
NPI:1124538350
Name:PLAINVIEW CHIROPRACTIC PA
Entity Type:Organization
Organization Name:PLAINVIEW CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CHAMBLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-429-5111
Mailing Address - Street 1:4304 OLTON RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-5810
Mailing Address - Country:US
Mailing Address - Phone:806-429-5111
Mailing Address - Fax:806-429-5131
Practice Address - Street 1:4304 OLTON RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-5810
Practice Address - Country:US
Practice Address - Phone:806-429-5111
Practice Address - Fax:806-429-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX618402OtherMEDICARE