Provider Demographics
NPI:1417636796
Name:AUTHENTIC CORE CARE PLLC
Entity Type:Organization
Organization Name:AUTHENTIC CORE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRIA
Authorized Official - Middle Name:MICHELLE ANN
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-798-8245
Mailing Address - Street 1:1201 ROAD TO SIX FLAGS ST E STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5044
Mailing Address - Country:US
Mailing Address - Phone:817-798-8245
Mailing Address - Fax:817-801-5444
Practice Address - Street 1:1201 ROAD TO SIX FLAGS ST E STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5044
Practice Address - Country:US
Practice Address - Phone:817-798-8245
Practice Address - Fax:817-801-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty