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General NPI Number Information
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NPI Number | 1649543026
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Entity Type | Organization
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Legal Business Name | NANCE CHIROPRACTIC CLINIC, P.C.
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 140 S VIRGINIA ST
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City | STEPHENVILLE
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State | TX
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Zip | 76401-4343
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Country | US
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Telephone | 254-965-6100
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Fax | 254-965-1904
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Provider Business Mailing Address
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Address Line | PO BOX 1726
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City | STEPHENVILLE
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State | TX
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Zip | 76401-0017
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Country | US
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Telephone | 254-965-6100
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Fax | 254-965-1904
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JERRY CHARLES NANCE
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Credential | DC
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Telephone | 254-965-6100
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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 | DC5104
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License Number State | TX
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