Provider Demographics
NPI:1457566622
Name:SCD BACK & JOINT CLINIC, LTD
Entity Type:Organization
Organization Name:SCD BACK & JOINT CLINIC, LTD
Other - Org Name:BACK & JOINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-822-2225
Mailing Address - Street 1:200 EAST 24TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803
Mailing Address - Country:US
Mailing Address - Phone:979-822-2225
Mailing Address - Fax:979-822-8445
Practice Address - Street 1:200 EAST 24TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803
Practice Address - Country:US
Practice Address - Phone:979-822-2225
Practice Address - Fax:979-822-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00118ZMedicare PIN