Provider Demographics
NPI:1922194042
Name:BROWN CAVETT BACK AND NECK CHIROPRACTIC
Entity Type:Organization
Organization Name:BROWN CAVETT BACK AND NECK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CAVETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-696-2211
Mailing Address - Street 1:4111 CALL FIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2516
Mailing Address - Country:US
Mailing Address - Phone:940-696-2211
Mailing Address - Fax:940-696-5641
Practice Address - Street 1:4111 CALL FIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2516
Practice Address - Country:US
Practice Address - Phone:940-696-2211
Practice Address - Fax:940-696-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000H16E8Medicaid