Provider Demographics
NPI:1326298381
Name:WEST TEXAS CLINIC OF CHIROPRACTIC
Entity Type:Organization
Organization Name:WEST TEXAS CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:POCHUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:806-293-4600
Mailing Address - Street 1:109 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7209
Mailing Address - Country:US
Mailing Address - Phone:806-293-4600
Mailing Address - Fax:806-288-9406
Practice Address - Street 1:109 W 9TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7209
Practice Address - Country:US
Practice Address - Phone:806-293-4600
Practice Address - Fax:806-288-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z952OtherMEDICARE PTAN