Provider Demographics
NPI:1457612137
Name:TEAMCHIRO TEXAS LLC
Entity Type:Organization
Organization Name:TEAMCHIRO TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-453-2800
Mailing Address - Street 1:2900 VILLAGE PKWY
Mailing Address - Street 2:350
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3300
Mailing Address - Country:US
Mailing Address - Phone:469-453-2800
Mailing Address - Fax:469-453-3131
Practice Address - Street 1:2900 VILLAGE PKWY
Practice Address - Street 2:350
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3300
Practice Address - Country:US
Practice Address - Phone:469-453-2800
Practice Address - Fax:469-453-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty