Provider Demographics
NPI:1487206900
Name:ETX CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:ETX CHIROPRACTIC, INC
Other - Org Name:ATLAS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RASCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-889-0983
Mailing Address - Street 1:1121 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2130
Mailing Address - Country:US
Mailing Address - Phone:903-759-5567
Mailing Address - Fax:903-759-5631
Practice Address - Street 1:1121 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2130
Practice Address - Country:US
Practice Address - Phone:903-759-5567
Practice Address - Fax:903-759-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790103448OtherNPI