Provider Demographics
NPI:1417148701
Name:ISDALE CORRECTIVE CHIROPRACTIC
Entity Type:Organization
Organization Name:ISDALE CORRECTIVE CHIROPRACTIC
Other - Org Name:ISDALE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-699-4004
Mailing Address - Street 1:716 INDIAN TRL STE 120
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5702
Mailing Address - Country:US
Mailing Address - Phone:254-698-1600
Mailing Address - Fax:254-698-1605
Practice Address - Street 1:716 INDIAN TRL STE 120
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5702
Practice Address - Country:US
Practice Address - Phone:254-698-1600
Practice Address - Fax:254-698-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty