Provider Demographics
NPI:1942513940
Name:BIG COUNTRY CLINIC OF CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:BIG COUNTRY CLINIC OF CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-721-0311
Mailing Address - Street 1:4150 SOUTHWEST DR STE 114
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-8292
Mailing Address - Country:US
Mailing Address - Phone:325-793-9989
Mailing Address - Fax:
Practice Address - Street 1:4150 SOUTHWEST DR STE 114
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8292
Practice Address - Country:US
Practice Address - Phone:325-793-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11496111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty