Provider Demographics
NPI:1417097189
Name:HEART OF TEXAS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:HEART OF TEXAS CHIROPRACTIC, INC.
Other - Org Name:HEART OF TEXAS HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-776-1030
Mailing Address - Street 1:PO BOX 7891
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76714-7891
Mailing Address - Country:US
Mailing Address - Phone:254-776-1030
Mailing Address - Fax:254-776-2832
Practice Address - Street 1:1545 WOODED ACRES DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2838
Practice Address - Country:US
Practice Address - Phone:254-776-1030
Practice Address - Fax:254-776-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015950 01Medicaid
TX0081DJOtherBLUE CROSS ID
TX00249RMedicare ID - Type Unspecified
TX0081DJOtherBLUE CROSS ID