Provider Demographics
NPI:1841490786
Name:MANSFIELD CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:MANSFIELD CHIROPRACTIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBBITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-453-3999
Mailing Address - Street 1:1071 COUNTRY CLUB DR
Mailing Address - Street 2:#101
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2663
Mailing Address - Country:US
Mailing Address - Phone:817-453-3999
Mailing Address - Fax:817-453-3970
Practice Address - Street 1:1071 COUNTRY CLUB DR
Practice Address - Street 2:#101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2663
Practice Address - Country:US
Practice Address - Phone:817-453-3999
Practice Address - Fax:817-453-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8793111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00106XMedicare PIN
TX8C1111Medicare UPIN