Provider Demographics
NPI:1265685911
Name:LAKE CITIES CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:LAKE CITIES CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-497-3147
Mailing Address - Street 1:4451 FM 2181
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-497-3147
Mailing Address - Fax:940-497-3148
Practice Address - Street 1:4451 FM 2181
Practice Address - Street 2:SUITE 120
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-497-3147
Practice Address - Fax:940-497-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX653072Medicare PIN
TXU82697Medicare UPIN
TX89422YMedicare PIN