Provider Demographics
NPI:1275715096
Name:MIDWAY FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MIDWAY FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-420-4669
Mailing Address - Street 1:1221 HEWITT DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8490
Mailing Address - Country:US
Mailing Address - Phone:254-420-4669
Mailing Address - Fax:254-420-4670
Practice Address - Street 1:1221 HEWITT DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8490
Practice Address - Country:US
Practice Address - Phone:254-420-4669
Practice Address - Fax:254-420-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606341OtherBCBS
TX00710WMedicare PIN