Provider Demographics
NPI:1669650511
Name:KEN NEWTON CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:KEN NEWTON CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-553-0955
Mailing Address - Street 1:414 W LOOP 281 STE 16
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4454
Mailing Address - Country:US
Mailing Address - Phone:903-553-0955
Mailing Address - Fax:093-553-0957
Practice Address - Street 1:414 W LOOP 281 STE 16
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4454
Practice Address - Country:US
Practice Address - Phone:903-553-0955
Practice Address - Fax:093-553-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-02
Last Update Date:2008-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4021261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601414Medicare PIN
TXT15032Medicare UPIN