Provider Demographics
NPI:1801006218
Name:GREEN OAKS CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:GREEN OAKS CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-483-3975
Mailing Address - Street 1:5609 SW GREEN OAKS BLVD
Mailing Address - Street 2:STE. 103
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1163
Mailing Address - Country:US
Mailing Address - Phone:817-483-3975
Mailing Address - Fax:817-478-8405
Practice Address - Street 1:5609 SW GREEN OAKS BLVD
Practice Address - Street 2:STE. 103
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1163
Practice Address - Country:US
Practice Address - Phone:817-483-3975
Practice Address - Fax:817-478-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU59363Medicare UPIN