Provider Demographics
NPI:1366857005
Name:21STCENTURYCHIROPRACTIC
Entity Type:Organization
Organization Name:21STCENTURYCHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-366-1133
Mailing Address - Street 1:2739 BACHMAN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-5852
Mailing Address - Country:US
Mailing Address - Phone:214-366-1133
Mailing Address - Fax:214-366-3916
Practice Address - Street 1:2739 BACHMAN DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-5852
Practice Address - Country:US
Practice Address - Phone:214-366-1133
Practice Address - Fax:214-366-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty