Provider Demographics
NPI:1710766167
Name:T-SPINE CHIROPRACTIC AND REHABILITATION LLC
Entity Type:Organization
Organization Name:T-SPINE CHIROPRACTIC AND REHABILITATION LLC
Other - Org Name:T/SPINE CHIROPRACTIC & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROWDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-866-6505
Mailing Address - Street 1:1018 E GOODE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-2563
Mailing Address - Country:US
Mailing Address - Phone:903-866-6505
Mailing Address - Fax:903-763-2550
Practice Address - Street 1:1018 E GOODE ST STE 102
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-2563
Practice Address - Country:US
Practice Address - Phone:903-866-6505
Practice Address - Fax:903-763-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty