Provider Demographics
NPI:1952129595
Name:IMEDTX LLC
Entity type:Organization
Organization Name:IMEDTX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:808-284-9899
Mailing Address - Street 1:204 S INTERSTATE 35 STE 101
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4125
Mailing Address - Country:US
Mailing Address - Phone:808-284-9899
Mailing Address - Fax:
Practice Address - Street 1:204 S INTERSTATE 35 STE 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4125
Practice Address - Country:US
Practice Address - Phone:808-284-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty