Provider Demographics
NPI:1710003637
Name:MAG MAG 99, PC
Entity Type:Organization
Organization Name:MAG MAG 99, PC
Other - Org Name:VERNON M BRYDER, DC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOCKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-872-9122
Mailing Address - Street 1:105 W 7TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110
Mailing Address - Country:US
Mailing Address - Phone:903-872-9122
Mailing Address - Fax:903-872-9071
Practice Address - Street 1:105 W. 7TH AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-6428
Practice Address - Country:US
Practice Address - Phone:903-872-9122
Practice Address - Fax:903-872-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty