Provider Demographics
NPI:1760665970
Name:KLESMIT HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:KLESMIT HEALTH CARE SERVICES, INC.
Other - Org Name:KLESMIT CHIROPRATIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KLESMIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-296-1566
Mailing Address - Street 1:1014 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2320
Mailing Address - Country:US
Mailing Address - Phone:972-296-1566
Mailing Address - Fax:972-296-3060
Practice Address - Street 1:1014 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2320
Practice Address - Country:US
Practice Address - Phone:972-296-1566
Practice Address - Fax:972-296-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00672NMedicare PIN
TXX47901Medicare UPIN