Provider Demographics
NPI:1184928467
Name:FARRIS CHIROPRACTIC OFFICE,INC.
Entity type:Organization
Organization Name:FARRIS CHIROPRACTIC OFFICE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:GEARALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-759-3651
Mailing Address - Street 1:3110 GILMER RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1439
Mailing Address - Country:US
Mailing Address - Phone:903-759-3651
Mailing Address - Fax:903-759-3659
Practice Address - Street 1:3110 GILMER RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1439
Practice Address - Country:US
Practice Address - Phone:903-759-3651
Practice Address - Fax:903-759-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-31
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX600268OtherPTAN
TXTI3232Medicare PIN