Provider Demographics
NPI:1861691958
Name:GROUP CHIROPRACTIC
Entity type:Organization
Organization Name:GROUP CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROUP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-330-0661
Mailing Address - Street 1:1406 CAMP CRAFT RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6573
Mailing Address - Country:US
Mailing Address - Phone:512-330-0661
Mailing Address - Fax:512-330-9118
Practice Address - Street 1:1406 CAMP CRAFT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6573
Practice Address - Country:US
Practice Address - Phone:512-330-0661
Practice Address - Fax:512-330-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8691111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4483Medicare PIN