Provider Demographics
NPI:1861688723
Name:MEXIA CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:MEXIA CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-562-2112
Mailing Address - Street 1:722 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-2957
Mailing Address - Country:US
Mailing Address - Phone:254-562-2112
Mailing Address - Fax:254-562-5266
Practice Address - Street 1:722 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-2957
Practice Address - Country:US
Practice Address - Phone:254-562-2112
Practice Address - Fax:254-562-5266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85W552OtherBLUECROSS BLUESHIELD
TXU74528OtherUPIN
TX85W552Medicare PIN