Provider Demographics
NPI:1558432591
Name:WEST TEXAS MULTICARE
Entity Type:Organization
Organization Name:WEST TEXAS MULTICARE
Other - Org Name:AMARILLO SPINE & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:DARIN
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-358-3595
Mailing Address - Street 1:#7 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106
Mailing Address - Country:US
Mailing Address - Phone:806-358-3595
Mailing Address - Fax:806-358-4647
Practice Address - Street 1:#7 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-358-3595
Practice Address - Fax:806-358-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0645Medicare ID - Type Unspecified
U82696Medicare UPIN