Provider Demographics
NPI:1720417157
Name:THE VINE FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:THE VINE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINT BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-514-2315
Mailing Address - Street 1:220 N PARK BLVD
Mailing Address - Street 2:STE 115
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6987
Mailing Address - Country:US
Mailing Address - Phone:405-514-2315
Mailing Address - Fax:
Practice Address - Street 1:220 N PARK BLVD
Practice Address - Street 2:STE 115
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6987
Practice Address - Country:US
Practice Address - Phone:405-514-2315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty