Provider Demographics
NPI:1942085501
Name:CISCO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CISCO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-784-3309
Mailing Address - Street 1:1700 CONRAD HILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CISCO
Mailing Address - State:TX
Mailing Address - Zip Code:76437-4857
Mailing Address - Country:US
Mailing Address - Phone:254-784-3309
Mailing Address - Fax:
Practice Address - Street 1:1498 I 20 W
Practice Address - Street 2:
Practice Address - City:CISCO
Practice Address - State:TX
Practice Address - Zip Code:76437-3672
Practice Address - Country:US
Practice Address - Phone:254-442-7643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty