Provider Demographics
NPI:1841475670
Name:TEXAS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:TEXAS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PROCTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-441-2810
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-0189
Mailing Address - Country:US
Mailing Address - Phone:817-441-2810
Mailing Address - Fax:817-441-2811
Practice Address - Street 1:213 OLD ANNETTA RD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008
Practice Address - Country:US
Practice Address - Phone:817-441-2810
Practice Address - Fax:817-441-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9372111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00317UMedicare PIN