Provider Demographics
NPI:1932225927
Name:ACADEMY REHAB CLINIC, PA
Entity Type:Organization
Organization Name:ACADEMY REHAB CLINIC, PA
Other - Org Name:ACADEMY REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGGHINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-295-8510
Mailing Address - Street 1:PO BOX 5440
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-5440
Mailing Address - Country:US
Mailing Address - Phone:903-295-8510
Mailing Address - Fax:903-295-3885
Practice Address - Street 1:1011 W LOOP 281
Practice Address - Street 2:SUITE 3
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2970
Practice Address - Country:US
Practice Address - Phone:903-295-8510
Practice Address - Fax:903-295-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX78JSOtherBLUE CROSS BLUE SHIELD
TX8212M0Medicare ID - Type Unspecified
TX78JSOtherBLUE CROSS BLUE SHIELD
TX00046RMedicare ID - Type UnspecifiedMEDICARE GROUP