Provider Demographics
NPI:1639372733
Name:ADDISON CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:ADDISON CHIROPRACTIC, PA
Other - Org Name:ADDISON CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:WITTE
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-789-9333
Mailing Address - Street 1:4540 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4515
Mailing Address - Country:US
Mailing Address - Phone:972-789-9333
Mailing Address - Fax:972-789-9557
Practice Address - Street 1:4540 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4515
Practice Address - Country:US
Practice Address - Phone:972-789-9333
Practice Address - Fax:972-789-9557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8594111N00000X
TX10196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097NCOtherBLUE CROSS GROUP NUMBER
TX0097NCOtherBLUE CROSS GROUP NUMBER