Provider Demographics
NPI:1316591951
Name:COUNTRYSIDE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:COUNTRYSIDE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-885-6029
Mailing Address - Street 1:5971 VIRGINIA PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5638
Mailing Address - Country:US
Mailing Address - Phone:942-546-0660
Mailing Address - Fax:942-546-0115
Practice Address - Street 1:5971 VIRGINIA PKWY STE 150
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5638
Practice Address - Country:US
Practice Address - Phone:942-546-0660
Practice Address - Fax:942-546-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty