Healthcare Provider Details

I. General information

NPI: 1356585541
Provider Name (Legal Business Name): CHICO FAMILY CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 NORTH WEATHERFORD ST
CHICO TX
76431-0511
US

IV. Provider business mailing address

PO BOX 511 101 NORTH WEATHERFORD ST
CHICO TX
76431-0511
US

V. Phone/Fax

Practice location:
  • Phone: 940-644-2568
  • Fax: 940-644-2067
Mailing address:
  • Phone: 940-644-2568
  • Fax: 940-644-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8843
License Number StateTX

VIII. Authorized Official

Name: DR. PAUL GORDON MCLEMORE
Title or Position: DOCTOR/OWNER
Credential: DC
Phone: 940-644-2568