Provider Demographics
NPI:1962641555
Name:LAS COLINAS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LAS COLINAS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:GEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-626-1126
Mailing Address - Street 1:6565 N MACARTHUR BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2482
Mailing Address - Country:US
Mailing Address - Phone:972-401-9100
Mailing Address - Fax:972-401-9102
Practice Address - Street 1:6565 N MACARTHUR BLVD STE 225
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2482
Practice Address - Country:US
Practice Address - Phone:972-401-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6280876002OtherCIGNA PAL NUMBER
TXDC5243OtherTEXAS LICENCE NUMBER
TX1962641555Medicaid
TX603200OtherBCBS OF TEXAS
TX0846492OtherUNITED HEALTHCARE
TX5819101OtherAETNA PROVIDER NUMBER
TX5243OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS
TX5819101OtherAETNA PROVIDER NUMBER