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General NPI Number Information
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NPI Number | 1487142824
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Entity Type | Organization
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Legal Business Name | BRIDLEWOOD CHIROPRACTIC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 100 COUNTRY VIEW DR STE 300
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City | ROANOKE
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State | TX
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Zip | 76262-2054
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Country | US
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Telephone | 682-237-2322
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Fax |
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Provider Business Mailing Address
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Address Line | 100 COUNTRY VIEW DR STE 300
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City | ROANOKE
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State | TX
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Zip | 76262-2054
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Country | US
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Telephone | 682-237-2322
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JENNA DENISE BECK
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Credential | DC
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Telephone | 682-237-2322
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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 | 12402
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License Number State | TX
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