Provider Demographics
NPI:1407010747
Name:CORE CHIROPRACTIC AND PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC AND PHYSICAL THERAPY
Other - Org Name:SANDY LAKE CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-393-8067
Mailing Address - Street 1:546 E SANDY LAKE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5786
Mailing Address - Country:US
Mailing Address - Phone:972-393-8067
Mailing Address - Fax:
Practice Address - Street 1:3400 LONG PRAIRIE ROAD
Practice Address - Street 2:SUITE100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2706
Practice Address - Country:US
Practice Address - Phone:972-393-8067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty