Provider Demographics
NPI:1174700314
Name:CHIROPRACTIC PROFESSIONALS OF LINDALE PC
Entity type:Organization
Organization Name:CHIROPRACTIC PROFESSIONALS OF LINDALE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-882-1828
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-8507
Mailing Address - Country:US
Mailing Address - Phone:903-882-1828
Mailing Address - Fax:903-882-0804
Practice Address - Street 1:1437 S MAIN
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771
Practice Address - Country:US
Practice Address - Phone:903-882-1828
Practice Address - Fax:903-882-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6470TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX862225OtherBLUE CROSS BLUE SHIELD
TXU71695Medicare UPIN
TX862225OtherBLUE CROSS BLUE SHIELD
TX85331KMedicare PIN