Provider Demographics
NPI:1821011818
Name:PRUITT CHIROPRACTIC CLINIC HEMPHILL, LLC
Entity Type:Organization
Organization Name:PRUITT CHIROPRACTIC CLINIC HEMPHILL, LLC
Other - Org Name:PRUITT CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:PRUITT
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-927-8482
Mailing Address - Street 1:2214 HEMPHILL STREET
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-2014
Mailing Address - Country:US
Mailing Address - Phone:817-927-8482
Mailing Address - Fax:817-927-8502
Practice Address - Street 1:2214 HEMPHILL STREET
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2014
Practice Address - Country:US
Practice Address - Phone:817-927-8482
Practice Address - Fax:817-927-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty