Provider Demographics
NPI:1659646131
Name:MASKE FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MASKE FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:MASKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-842-2923
Mailing Address - Street 1:1514 N GREENVILLE AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1202
Mailing Address - Country:US
Mailing Address - Phone:214-842-2923
Mailing Address - Fax:877-466-7919
Practice Address - Street 1:1514 N GREENVILLE AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1202
Practice Address - Country:US
Practice Address - Phone:214-842-2923
Practice Address - Fax:877-466-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11555111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty