Provider Demographics
NPI:1285813808
Name:CHIROPRACTIC FIRST
Entity Type:Organization
Organization Name:CHIROPRACTIC FIRST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:936-334-0004
Mailing Address - Street 1:PO BOX 4096
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-2296
Mailing Address - Country:US
Mailing Address - Phone:936-334-0004
Mailing Address - Fax:936-334-0010
Practice Address - Street 1:2000A PANTHER LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3251
Practice Address - Country:US
Practice Address - Phone:936-334-0004
Practice Address - Fax:936-334-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181645601Medicaid
TX0091JYOtherBC/BS
TX00231VMedicare PIN
TX613495Medicare PIN
TX0091JYOtherBC/BS