Healthcare Provider Details

I. General information

NPI: 1154440949
Provider Name (Legal Business Name): B.C.C. INC.APCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 N STATE LINE AVE
TEXARKANA TX
75503-3132
US

IV. Provider business mailing address

900 W AIRLINE HWY
LA PLACE LA
70068-3816
US

V. Phone/Fax

Practice location:
  • Phone: 903-792-3763
  • Fax: 903-792-6898
Mailing address:
  • Phone: 985-653-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number7000
License Number StateTX

VIII. Authorized Official

Name: MS. TERRI W BLOUIN
Title or Position: INSURANCE SUPERVISOR
Credential:
Phone: 985-653-8903