Provider Demographics
NPI:1205055944
Name:VILLAGE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:VILLAGE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RAUHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-317-2612
Mailing Address - Street 1:2430 JUSTIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3091
Mailing Address - Country:US
Mailing Address - Phone:972-317-3146
Mailing Address - Fax:972-317-4417
Practice Address - Street 1:2430 JUSTIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3091
Practice Address - Country:US
Practice Address - Phone:972-317-3146
Practice Address - Fax:972-317-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF002028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035BRMedicare ID - Type Unspecified
TXU2697Medicare UPIN