Provider Demographics
NPI:1689895872
Name:HILL COUNTRY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HILL COUNTRY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FABLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-964-3032
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-0021
Mailing Address - Country:US
Mailing Address - Phone:830-964-3032
Mailing Address - Fax:830-964-4460
Practice Address - Street 1:1742 FM 2673
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-4743
Practice Address - Country:US
Practice Address - Phone:830-964-3032
Practice Address - Fax:830-964-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4226111N00000X
TX10498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF01921Medicare UPIN
TX00R81RMedicare PIN