Provider Demographics
NPI:1598801342
Name:GENESIS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:GENESIS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-378-9991
Mailing Address - Street 1:6101 WINDCOM CT
Mailing Address - Street 2:STE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6101 WINDCOM CT
Practice Address - Street 2:STE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7817
Practice Address - Country:US
Practice Address - Phone:972-378-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0098HDOtherBCBS
TX5937120002Medicare NSC
TX00614TMedicare ID - Type Unspecified
TX0098HDOtherBCBS