Provider Demographics
NPI:1689759607
Name:AY CHIROPRACTIC,PLLC
Entity Type:Organization
Organization Name:AY CHIROPRACTIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMINA
Authorized Official - Middle Name:TASKEAN
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-323-4970
Mailing Address - Street 1:PO BOX 261413
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-1413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2067 N CENTRAL EXPY STE 104
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2760
Practice Address - Country:US
Practice Address - Phone:469-323-4970
Practice Address - Fax:972-994-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V9690OtherBLUE CROSS BLUE SHIELD
TXV03482Medicare UPIN
00X506Medicare PIN