Provider Demographics
NPI:1538626304
Name:PORT ARTHUR CHIROPRACTIC
Entity type:Organization
Organization Name:PORT ARTHUR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-527-8864
Mailing Address - Street 1:3009 STRAWBERRY RD STE B
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-5216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1907 JEFFERSON DR STE 350
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2174
Practice Address - Country:US
Practice Address - Phone:409-999-6035
Practice Address - Fax:409-998-6032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED PROVIDERS OF TEXAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty