Provider Demographics
NPI:1891916896
Name:AFFINITY2 HEALTH CARE, L.L.C.
Entity Type:Organization
Organization Name:AFFINITY2 HEALTH CARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-583-7411
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4322
Mailing Address - Country:US
Mailing Address - Phone:903-583-7411
Mailing Address - Fax:903-583-9601
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4322
Practice Address - Country:US
Practice Address - Phone:903-583-7411
Practice Address - Fax:903-583-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4273111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0073GWOtherBLUE CROSS GROUP NUMBER
TX00759RMedicare ID - Type UnspecifiedGROUP NUMBER
TX0073GWOtherBLUE CROSS GROUP NUMBER