Provider Demographics
NPI:1376729731
Name:TWO STOREY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:TWO STOREY CHIROPRACTIC PA
Other - Org Name:STOREY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-949-1518
Mailing Address - Street 1:2412 COLLEGE HILLS BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-8425
Mailing Address - Country:US
Mailing Address - Phone:325-949-1518
Mailing Address - Fax:325-223-9290
Practice Address - Street 1:2412 COLLEGE HILLS BLVD STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8425
Practice Address - Country:US
Practice Address - Phone:325-949-1518
Practice Address - Fax:325-223-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU67200Medicare UPIN
TX605727Medicare PIN