Provider Demographics
NPI:1679893077
Name:DORN CARE CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:DORN CARE CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KYM
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-690-7090
Mailing Address - Street 1:3901 E STAN SCHLUETER LOOP
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4516
Mailing Address - Country:US
Mailing Address - Phone:254-690-7090
Mailing Address - Fax:254-690-8850
Practice Address - Street 1:3901 E STAN SCHLUETER LOOP
Practice Address - Street 2:SUITE 205
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4516
Practice Address - Country:US
Practice Address - Phone:254-690-7090
Practice Address - Fax:254-690-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2011-08-10
Deactivation Date:2010-08-09
Deactivation Code:
Reactivation Date:2010-10-28
Provider Licenses
StateLicense IDTaxonomies
TX6987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87726OtherUNITED HEALTH CARE
TX84980OtherBLUE CROSS BLUE SHIELD
TX62413OtherMAILHANDLERS
TX44054OtherGEHA
TX60054OtherAETNA
TX62308OtherCIGNA
TX94999OtherFIRSTCARE
TX61101OtherHUMANA
TX44054OtherGEHA