Provider Demographics
NPI:1356585541
Name:CHICO FAMILY CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:CHICO FAMILY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-644-2568
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:101 NORTH WEATHERFORD ST
Mailing Address - City:CHICO
Mailing Address - State:TX
Mailing Address - Zip Code:76431-0511
Mailing Address - Country:US
Mailing Address - Phone:940-644-2568
Mailing Address - Fax:940-644-2067
Practice Address - Street 1:101 NORTH WEATHERFORD ST
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:TX
Practice Address - Zip Code:76431-0511
Practice Address - Country:US
Practice Address - Phone:940-644-2568
Practice Address - Fax:940-644-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU84904Medicare UPIN