Provider Demographics
NPI:1932642642
Name:TEMPLE SPORT AND SPINE CHIROPRACTIC
Entity Type:Organization
Organization Name:TEMPLE SPORT AND SPINE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-598-1155
Mailing Address - Street 1:6001 STATE HIGHWAY 317
Mailing Address - Street 2:UNIT A
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-5464
Mailing Address - Country:US
Mailing Address - Phone:254-598-1155
Mailing Address - Fax:254-262-0052
Practice Address - Street 1:6001 STATE HIGHWAY 317
Practice Address - Street 2:UNIT A
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-5464
Practice Address - Country:US
Practice Address - Phone:254-598-1155
Practice Address - Fax:254-262-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty