Provider Demographics
NPI:1558437095
Name:PROHEALTH SPINE CARE INC.
Entity Type:Organization
Organization Name:PROHEALTH SPINE CARE INC.
Other - Org Name:PROHEALTH CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:BRICE
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-874-2211
Mailing Address - Street 1:200 N 15TH ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-4536
Mailing Address - Country:US
Mailing Address - Phone:903-874-2211
Mailing Address - Fax:903-874-0147
Practice Address - Street 1:200 N 15TH ST
Practice Address - Street 2:SUITE 15
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-4536
Practice Address - Country:US
Practice Address - Phone:903-874-2211
Practice Address - Fax:903-874-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty