Provider Demographics
NPI:1316368772
Name:HUGHLETT CHIROPRACTIC PA
Entity Type:Organization
Organization Name:HUGHLETT CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUGHLETT
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:817-451-7575
Mailing Address - Street 1:3921 W GREEN OAKS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2764
Mailing Address - Country:US
Mailing Address - Phone:817-451-7575
Mailing Address - Fax:817-451-1250
Practice Address - Street 1:3921 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2764
Practice Address - Country:US
Practice Address - Phone:817-451-7575
Practice Address - Fax:817-451-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609852OtherMEDICARE ID UNSPECIFIED
TXU96206Medicare UPIN