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General NPI Number Information
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NPI Number | 1316591951
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Entity Type | Organization
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Legal Business Name | COUNTRYSIDE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 5971 VIRGINIA PKWY STE 150
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City | MCKINNEY
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State | TX
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Zip | 75071-5638
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Country | US
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Telephone | 942-546-0660
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Fax | 942-546-0115
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Provider Business Mailing Address
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Address Line | 5971 VIRGINIA PKWY STE 150
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City | MCKINNEY
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State | TX
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Zip | 75071-5638
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Country | US
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Telephone | 942-546-0660
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Fax | 942-546-0115
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC C ROSS
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Credential | DC
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Telephone | 801-885-6029
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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 |
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License Number State |
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