Provider Demographics
NPI:1174640213
Name:CROSSROADS NATURAL HEALTH, LLC
Entity Type:Organization
Organization Name:CROSSROADS NATURAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-641-7111
Mailing Address - Street 1:PO BOX 540369
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0369
Mailing Address - Country:US
Mailing Address - Phone:972-641-7111
Mailing Address - Fax:972-660-1119
Practice Address - Street 1:3125 S CARRIER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3735
Practice Address - Country:US
Practice Address - Phone:972-641-7111
Practice Address - Fax:972-660-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050PDOtherBLUE CROSS BLUE SHIELD
TX00W309Medicare PIN
TXU66132Medicare UPIN