Provider Demographics
NPI:1154638864
Name:BRATCHER CHIROPRACTIC DIAGNOSTIC CENTER PC
Entity Type:Organization
Organization Name:BRATCHER CHIROPRACTIC DIAGNOSTIC CENTER PC
Other - Org Name:BRATCHER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-561-6676
Mailing Address - Street 1:2140 GRANDE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0563
Mailing Address - Country:US
Mailing Address - Phone:903-561-6676
Mailing Address - Fax:903-561-7071
Practice Address - Street 1:2140 GRANDE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0563
Practice Address - Country:US
Practice Address - Phone:903-561-6676
Practice Address - Fax:903-561-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600027Medicare PIN
TXT12348Medicare UPIN