Provider Demographics
NPI:1972742575
Name:AGGIELAND CHIROPRACTIC & WELLNESS CENTER PC
Entity Type:Organization
Organization Name:AGGIELAND CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-703-8090
Mailing Address - Street 1:505 UNIVERSITY DR E STE 803
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-1747
Mailing Address - Country:US
Mailing Address - Phone:979-703-8090
Mailing Address - Fax:979-703-8091
Practice Address - Street 1:505 UNIVERSITY DR E STE 803
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-1747
Practice Address - Country:US
Practice Address - Phone:979-703-8090
Practice Address - Fax:979-703-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty