Provider Demographics
NPI:1700921897
Name:MINORS CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:MINORS CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINORS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-480-9999
Mailing Address - Street 1:4006 S LAMAR BLVD
Mailing Address - Street 2:STE 650
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8802
Mailing Address - Country:US
Mailing Address - Phone:512-480-9999
Mailing Address - Fax:
Practice Address - Street 1:4006 S LAMAR BLVD
Practice Address - Street 2:STE 650
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8802
Practice Address - Country:US
Practice Address - Phone:512-480-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC 7035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC7035OtherLICENSE NUMBER
TX76HJOtherBCBS FACILITY PROVIDER #
TXDC7035OtherLICENSE NUMBER