Provider Demographics
NPI:1235416900
Name:PECAN VALLEY CHIROPRACTIC & REHAB, LLC
Entity Type:Organization
Organization Name:PECAN VALLEY CHIROPRACTIC & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:SCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-646-8237
Mailing Address - Street 1:801 EARLY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2130
Mailing Address - Country:US
Mailing Address - Phone:325-646-8237
Mailing Address - Fax:325-643-9856
Practice Address - Street 1:801 EARLY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2130
Practice Address - Country:US
Practice Address - Phone:325-646-8237
Practice Address - Fax:325-643-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU71474Medicare UPIN