Provider Demographics
NPI:1134314487
Name:CORINTH CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:CORINTH CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-270-2222
Mailing Address - Street 1:4851 S INTERSTATE 35 E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-2348
Mailing Address - Country:US
Mailing Address - Phone:940-270-2222
Mailing Address - Fax:940-269-2223
Practice Address - Street 1:4851 S INTERSTATE 35 E
Practice Address - Street 2:SUITE 202
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2348
Practice Address - Country:US
Practice Address - Phone:940-270-2222
Practice Address - Fax:940-269-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00150XOtherBCBS GROUP
TXV00734Medicare UPIN