Provider Demographics
NPI:1205009412
Name:EIGHTEEN95, PA
Entity Type:Organization
Organization Name:EIGHTEEN95, PA
Other - Org Name:HANDS ON HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-421-4775
Mailing Address - Street 1:3500 WILLIAM D. TATE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-421-4775
Mailing Address - Fax:817-421-4303
Practice Address - Street 1:3500 WILLIAM D. TATE
Practice Address - Street 2:SUITE 175
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-421-4775
Practice Address - Fax:817-421-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9378111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608860OtherBCBS
TXV115395OtherINTEGRATED HEALTH PLAN
TX8BB730OtherBCBS
TX609793Medicare PIN