Provider Demographics
NPI:1679793293
Name:CASA VIEW CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:CASA VIEW CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:972-270-6405
Mailing Address - Street 1:10622 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-2604
Mailing Address - Country:US
Mailing Address - Phone:972-270-6405
Mailing Address - Fax:972-613-1775
Practice Address - Street 1:10622 SHILOH RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-2604
Practice Address - Country:US
Practice Address - Phone:972-270-6405
Practice Address - Fax:972-613-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6524111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty