Provider Demographics
NPI:1730365651
Name:TRANQUILITY HEALTH CENTERS, PC
Entity type:Organization
Organization Name:TRANQUILITY HEALTH CENTERS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-774-5300
Mailing Address - Street 1:PO BOX 12410
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-2410
Mailing Address - Country:US
Mailing Address - Phone:979-774-5300
Mailing Address - Fax:979-776-5173
Practice Address - Street 1:1121 BRIARCREST DR
Practice Address - Street 2:SUITE #100
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2505
Practice Address - Country:US
Practice Address - Phone:979-268-0786
Practice Address - Fax:979-846-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8580111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025QWOtherBCBS
TX0025QWOtherBCBS
TX00Z183Medicare PIN