Provider Demographics
NPI:1619497401
Name:FOUR-TEN ENTERPRISE, LLC
Entity Type:Organization
Organization Name:FOUR-TEN ENTERPRISE, LLC
Other - Org Name:HELPING HANDS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-597-9021
Mailing Address - Street 1:1540 RICE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3223
Mailing Address - Country:US
Mailing Address - Phone:903-597-9021
Mailing Address - Fax:903-597-0840
Practice Address - Street 1:1540 RICE RD STE 400
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3223
Practice Address - Country:US
Practice Address - Phone:903-597-9021
Practice Address - Fax:903-597-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12808111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX583248OtherMEDICARE