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General NPI Number Information
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NPI Number | 1598961674
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CENTER OF EAST TEXAS
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 181 COUNTY ROAD 238
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City | NACOGDOCHES
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State | TX
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Zip | 75961-7305
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Country | US
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Telephone | 936-560-1113
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Fax | 936-560-3024
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | MARTINSVILLE
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State | TX
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Zip | 75958-0159
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Country | US
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Telephone | 936-560-1113
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Fax | 936-560-3024
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. TREACY COLLEEN HAGAN
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Credential | DC
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Telephone | 936-560-1113
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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 | 6125
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5968
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License Number State | TX
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