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General NPI Number Information
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NPI Number | 1073621223
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Entity Type | Organization
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Legal Business Name | ISDALE CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 WINKLER AVE
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City | KILLEEN
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State | TX
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Zip | 76542-6108
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Country | US
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Telephone | 254-699-4004
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Fax | 254-699-4056
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Provider Business Mailing Address
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Address Line | 1201 WINKLER AVE
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City | KILLEEN
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State | TX
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Zip | 76542-6108
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Country | US
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Telephone | 254-699-4004
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Fax | 254-699-4056
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Authorized Official
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Title or Position | DOCTOR / OWNER
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Name | DR. SCOTT EDWARD ISDALE
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Credential | D.C.
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Telephone | 254-699-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2385
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License Number State | TX
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