Provider Demographics
NPI: | 1427553130 |
---|---|
Name: | CHIROATHLETICS PLLC |
Entity Type: | Organization |
Organization Name: | CHIROATHLETICS PLLC |
Other - Org Name: | KC CORE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | Y |
Authorized Official - Last Name: | CHANG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 413-717-0475 |
Mailing Address - Street 1: | 301 VALLEY COVE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | GARLAND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75043-2954 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 413-717-0475 |
Mailing Address - Fax: | 855-644-7364 |
Practice Address - Street 1: | 4401 COIT RD STE 403 |
Practice Address - Street 2: | |
Practice Address - City: | FRISCO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75035-0516 |
Practice Address - Country: | US |
Practice Address - Phone: | 214-295-4321 |
Practice Address - Fax: | 855-644-7364 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-03-26 |
Last Update Date: | 2018-03-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |