Provider Demographics
NPI:1255539425
Name:EASTSIDE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:EASTSIDE FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENABNIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:409-838-7800
Mailing Address - Street 1:PO BOX 23074
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-3074
Mailing Address - Country:US
Mailing Address - Phone:409-838-7800
Mailing Address - Fax:409-838-7810
Practice Address - Street 1:3282 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4610
Practice Address - Country:US
Practice Address - Phone:709-838-7800
Practice Address - Fax:409-838-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5419261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7091OtherBLUE CROSS & BLUE SHIELD
TX00W074Medicare UPIN