Provider Demographics
NPI:1528213634
Name:CORRECTIVE CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEGENHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-698-1600
Mailing Address - Street 1:716 INDIAN TRL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5700
Mailing Address - Country:US
Mailing Address - Phone:254-698-1600
Mailing Address - Fax:
Practice Address - Street 1:716 INDIAN TRL
Practice Address - Street 2:SUITE 120
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5700
Practice Address - Country:US
Practice Address - Phone:254-698-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB118036Medicare UPIN
TXTXB116573Medicare UPIN