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1275643025 NPI number — WALTER T EIDSON DC

NPI Number: 1275643025
Health Care Provider/Practitioner: WALTER T EIDSON DC

Information about “1275643025” NPI (WALTER T EIDSON DC) exists in 1275643025 in HTML format HTML  |  1275643025 in plain Text format TXT  |  1275643025 in PDF (Portable Document Format) PDF  |  1275643025 in an XML format XML  formats.

NPI Number : 1275643025 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275643025",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EIDSON",
    "FirstName": "WALTER",
    "MiddleName": "T",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 13120",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ARLINGTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76094-0120",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-795-7200",
    "MailingAddressFaxNumber": "817-275-3287",
    "FirstLinePracticeLocationAddress": "2542 W PIONEER PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARLINGTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76013-5902",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-795-7200",
    "PracticeLocationAddressFaxNumber": "817-275-3287",
    "EnumerationDate": "08/30/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "4582 TX",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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