Provider Demographics
NPI:1710058276
Name:HUNTER CHIROPRACTIC HEALTH CENTER INC
Entity Type:Organization
Organization Name:HUNTER CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-759-7595
Mailing Address - Street 1:2706 BILL OWENS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2136
Mailing Address - Country:US
Mailing Address - Phone:903-759-7595
Mailing Address - Fax:903-759-2672
Practice Address - Street 1:2706 BILL OWENS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2136
Practice Address - Country:US
Practice Address - Phone:903-759-7595
Practice Address - Fax:903-759-2672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6164111N00000X
TX10945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU50685Medicare UPIN
TXGRP 00704X ID# 8C882Medicare ID - Type Unspecified