Healthcare Provider Details

I. General information

NPI: 1700293453
Provider Name (Legal Business Name): LAKE TEXOMA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81750 N STATE HWY 289 STE 102
POTTSBORO TX
75076
US

IV. Provider business mailing address

81750 N STATE HWY 289 STE 102
POTTSBORO TX
75076-4966
US

V. Phone/Fax

Practice location:
  • Phone: 903-327-9166
  • Fax: 888-886-8139
Mailing address:
  • Phone: 330-482-9350
  • Fax: 330-482-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009315
License Number StatePA

VIII. Authorized Official

Name: MRS. NATALIE ANN BEIGHT
Title or Position: OWNER
Credential: DC
Phone: 903-327-9166