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General NPI Number Information
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NPI Number | 1316022346
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Entity Type | Organization
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Legal Business Name | CEDAR CREEK HEALTHCARE, PC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1833 W MAIN ST
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-4401
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Country | US
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Telephone | 903-887-6155
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Fax | 903-887-6755
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Provider Business Mailing Address
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Address Line | 1833 W MAIN ST
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City | GUN BARREL CITY
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State | TX
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Zip | 75156-4401
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Country | US
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Telephone | 903-887-6155
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Fax | 903-887-6755
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SOI SY
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Credential |
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Telephone | 903-887-6155
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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 | 8867
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License Number State | TX
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