Provider Demographics
NPI:1881709392
Name:YOAKUM CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:YOAKUM CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:361-293-2022
Mailing Address - Street 1:101 N KENEDY ST
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-3601
Mailing Address - Country:US
Mailing Address - Phone:361-293-2022
Mailing Address - Fax:361-293-3821
Practice Address - Street 1:101 N KENEDY ST
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-3601
Practice Address - Country:US
Practice Address - Phone:361-293-2022
Practice Address - Fax:361-293-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096JVOtherBLUE CROSS
TX0096JVOtherBLUE CROSS
TXT14529Medicare UPIN