Provider Demographics
NPI:1790885382
Name:WASSENBERG CHIROPRACTIC HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:WASSENBERG CHIROPRACTIC HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WASSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:432-697-9797
Mailing Address - Street 1:3313 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5148
Mailing Address - Country:US
Mailing Address - Phone:432-697-9797
Mailing Address - Fax:432-697-6891
Practice Address - Street 1:3313 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5148
Practice Address - Country:US
Practice Address - Phone:432-697-9797
Practice Address - Fax:432-697-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6305Medicare PIN