Provider Demographics
NPI:1740466754
Name:DEHART CHIROPRACTIC CLINIC PLLC
Entity type:Organization
Organization Name:DEHART CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-566-1660
Mailing Address - Street 1:1503 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3021
Mailing Address - Country:US
Mailing Address - Phone:940-566-1660
Mailing Address - Fax:
Practice Address - Street 1:1503 N ELM ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3021
Practice Address - Country:US
Practice Address - Phone:940-566-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6982111N00000X
TX9639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B8352Medicare PIN
TX605562Medicare PIN