Provider Demographics
NPI:1518140821
Name:H.Q. CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:H.Q. CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CASEY
Authorized Official - Last Name:QUIROZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-363-8182
Mailing Address - Street 1:4100 BONHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-6204
Mailing Address - Country:US
Mailing Address - Phone:432-363-8182
Mailing Address - Fax:432-363-0952
Practice Address - Street 1:4100 BONHAM AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-6204
Practice Address - Country:US
Practice Address - Phone:432-363-8182
Practice Address - Fax:432-363-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX10226DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1215955521OtherINDIVIDUAL TYPE 1 NPI