Provider Demographics
NPI:1235205881
Name:ISBELL CHIROPRACTIC
Entity Type:Organization
Organization Name:ISBELL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ISBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-539-0901
Mailing Address - Street 1:PO BOX 132858
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-2858
Mailing Address - Country:US
Mailing Address - Phone:903-539-0901
Mailing Address - Fax:903-526-5006
Practice Address - Street 1:4295 KINSEY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1004
Practice Address - Country:US
Practice Address - Phone:903-526-5000
Practice Address - Fax:903-526-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4157111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00118TMedicare ID - Type Unspecified
T13999Medicare UPIN