Provider Demographics
NPI:1942385208
Name:HEALTH BUILDERS CHIROPRACTIC PA
Entity Type:Organization
Organization Name:HEALTH BUILDERS CHIROPRACTIC PA
Other - Org Name:TEXAS INJURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WINSLOW
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-624-7222
Mailing Address - Street 1:2121 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-8588
Mailing Address - Country:US
Mailing Address - Phone:817-624-7222
Mailing Address - Fax:817-624-7233
Practice Address - Street 1:2121 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76164-8588
Practice Address - Country:US
Practice Address - Phone:817-624-7222
Practice Address - Fax:817-624-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0006CPOtherBLUE CROSS
TX00266YMedicare ID - Type UnspecifiedMEDICARE GROUP