Provider Demographics
NPI:1730216888
Name:MAPLES CHIROPRACTIC GROUP, PC
Entity type:Organization
Organization Name:MAPLES CHIROPRACTIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:MAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-295-7722
Mailing Address - Street 1:709 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-4024
Mailing Address - Country:US
Mailing Address - Phone:903-295-7722
Mailing Address - Fax:903-295-7755
Practice Address - Street 1:709 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-4024
Practice Address - Country:US
Practice Address - Phone:903-295-7722
Practice Address - Fax:903-295-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00647KMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER