Provider Demographics
NPI:1922295500
Name:KILLEEN AFFORDABLE CHIROPRACTIC
Entity Type:Organization
Organization Name:KILLEEN AFFORDABLE CHIROPRACTIC
Other - Org Name:AFFORDABLE CHIROPRACTIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-526-6151
Mailing Address - Street 1:1010 W JASPER DR STE 6
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-1328
Mailing Address - Country:US
Mailing Address - Phone:254-526-6151
Mailing Address - Fax:
Practice Address - Street 1:1010 W JASPER DR STE 6
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1328
Practice Address - Country:US
Practice Address - Phone:254-526-6151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty