Provider Demographics
NPI:1477747426
Name:CONLIN CHIROPRACTIC
Entity Type:Organization
Organization Name:CONLIN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:B
Authorized Official - Last Name:CONLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-356-8000
Mailing Address - Street 1:3501 S GEORGIA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4856
Mailing Address - Country:US
Mailing Address - Phone:806-356-8000
Mailing Address - Fax:806-356-0400
Practice Address - Street 1:3501 S GEORGIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4856
Practice Address - Country:US
Practice Address - Phone:806-356-8000
Practice Address - Fax:806-356-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W057Medicare PIN