Healthcare Provider Details

I. General information

NPI: 1316022346
Provider Name (Legal Business Name): CEDAR CREEK HEALTHCARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 W MAIN ST
GUN BARREL CITY TX
75156-4401
US

IV. Provider business mailing address

1833 W MAIN ST
GUN BARREL CITY TX
75156-4401
US

V. Phone/Fax

Practice location:
  • Phone: 903-887-6155
  • Fax: 903-887-6755
Mailing address:
  • Phone: 903-887-6155
  • Fax: 903-887-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8867
License Number StateTX

VIII. Authorized Official

Name: DR. SOI SY
Title or Position: DOCTOR
Credential:
Phone: 903-887-6155