Provider Demographics
NPI:1710484597
Name:EPIC CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:EPIC CHIROPRACTIC, LLC
Other - Org Name:LEGACY SPINE AND NERVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPROUL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-783-0644
Mailing Address - Street 1:5318 114TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6621
Mailing Address - Country:US
Mailing Address - Phone:806-783-0644
Mailing Address - Fax:806-224-0428
Practice Address - Street 1:5318 114TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-6621
Practice Address - Country:US
Practice Address - Phone:806-783-0644
Practice Address - Fax:806-224-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty