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General NPI Number Information
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NPI Number | 1255881728
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Entity Type | Organization
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Legal Business Name | WAXAHACHIE CHIROPRACTIC
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Dates
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Enumeration Date | 10/09/2016
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Last Update Date | 10/09/2016
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Provider Practice Location Address
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Address Line | 1795 N HIGHWAY 77 STE 104
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City | WAXAHACHIE
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State | TX
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Zip | 75165-7868
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Country | US
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Telephone | 972-937-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 1795 N HIGHWAY 77 STE 104
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City | WAXAHACHIE
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State | TX
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Zip | 75165-7868
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Country | US
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Telephone | 972-937-3100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BRENDA ROSS
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Credential | DC
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Telephone | 972-937-3100
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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 | DC6959
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License Number State | TX
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