Healthcare Provider Details

I. General information

NPI: 1598961674
Provider Name (Legal Business Name): CHIROPRACTIC CENTER OF EAST TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 COUNTY ROAD 238
NACOGDOCHES TX
75961-7305
US

IV. Provider business mailing address

PO BOX 159
MARTINSVILLE TX
75958-0159
US

V. Phone/Fax

Practice location:
  • Phone: 936-560-1113
  • Fax: 936-560-3024
Mailing address:
  • Phone: 936-560-1113
  • Fax: 936-560-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6125
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5968
License Number StateTX

VIII. Authorized Official

Name: DR. TREACY COLLEEN HAGAN
Title or Position: CO-OWNER
Credential: DC
Phone: 936-560-1113