Provider Demographics
NPI:1205956786
Name:CROSSROADS CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:CROSSROADS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-695-0090
Mailing Address - Street 1:4102 BUFFALO GAP RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-7248
Mailing Address - Country:US
Mailing Address - Phone:325-695-0090
Mailing Address - Fax:325-695-0090
Practice Address - Street 1:4102 BUFFALO GAP RD
Practice Address - Street 2:SUITE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-7248
Practice Address - Country:US
Practice Address - Phone:325-695-0090
Practice Address - Fax:325-695-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4562111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty