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General NPI Number Information
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NPI Number | 1376091447
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Entity Type | Organization
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Legal Business Name | ABSOLUTE CHIROPRACTIC
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 201 W PINECREST DR
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City | MARSHALL
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State | TX
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Zip | 75670-7173
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Country | US
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Telephone | 903-938-5454
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W PINECREST DR
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City | MARSHALL
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State | TX
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Zip | 75670-7173
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Country | US
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Telephone | 903-938-5454
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | LANCE COOK
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Credential | D.C.
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Telephone | 903-938-5454
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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 | 6535
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License Number State | TX
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