Provider Demographics
NPI:1427034362
Name:ABC CHIROPRACTIC PA
Entity Type:Organization
Organization Name:ABC CHIROPRACTIC PA
Other - Org Name:RJS EXAM SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-775-8451
Mailing Address - Street 1:PO BOX 3948
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-3948
Mailing Address - Country:US
Mailing Address - Phone:979-775-8451
Mailing Address - Fax:979-823-4991
Practice Address - Street 1:322 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803
Practice Address - Country:US
Practice Address - Phone:979-775-8451
Practice Address - Fax:979-823-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6119DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5208520OtherAETNA
TX8K8200OtherBCBS
TX8K8200OtherBCBS
5208520OtherAETNA