Provider Demographics
NPI:1619128550
Name:AMARILLO SOUTH CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:AMARILLO SOUTH CHIROPRACTIC PLLC
Other - Org Name:AMARILLO SOUTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-679-3543
Mailing Address - Street 1:1157 SUGARLOAF DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-3518
Mailing Address - Country:US
Mailing Address - Phone:806-679-3543
Mailing Address - Fax:
Practice Address - Street 1:1157 SUGARLOAF DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-3518
Practice Address - Country:US
Practice Address - Phone:806-679-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10997111N00000X
TX1141224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty