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General NPI Number Information
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NPI Number | 1205055944
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Entity Type | Organization
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Legal Business Name | VILLAGE CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 2430 JUSTIN RD SUITE B
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City | HIGHLAND VILLAGE
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State | TX
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Zip | 75077-3091
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Country | US
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Telephone | 972-317-3146
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Fax | 972-317-4417
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Provider Business Mailing Address
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Address Line | 2430 JUSTIN RD SUITE B
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City | HIGHLAND VILLAGE
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State | TX
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Zip | 75077-3091
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Country | US
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Telephone | 972-317-3146
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Fax | 972-317-4417
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEREMY DALE RAUHAUSER
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Credential | D.C.
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Telephone | 972-317-2612
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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 | F002028
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License Number State | TX
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