Provider Demographics
NPI:1851788780
Name:FLETCHER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:FLETCHER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALKER
Authorized Official - Middle Name:LANDEN
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-643-2225
Mailing Address - Street 1:1700 WILDCAT DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2817
Mailing Address - Country:US
Mailing Address - Phone:361-643-2225
Mailing Address - Fax:361-643-2227
Practice Address - Street 1:1700 WILDCAT DR
Practice Address - Street 2:SUITE C
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2817
Practice Address - Country:US
Practice Address - Phone:361-643-2225
Practice Address - Fax:361-643-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1503534-01Medicaid
TX1503534-01Medicaid
609722Medicare PIN