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General NPI Number Information
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NPI Number | 1316593551
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CLINIC OF CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 210 LAFAYETTE ST
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City | PITTSBURG
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State | TX
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Zip | 75686-1630
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Country | US
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Telephone | 903-563-9501
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Fax |
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Provider Business Mailing Address
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Address Line | 140 COUNTY ROAD 4425
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City | MT PLEASANT
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State | TX
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Zip | 75455-8686
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Country | US
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Telephone | 903-563-9501
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARTH JOHNSON
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Credential | DC
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Telephone | 903-563-9501
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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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