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General NPI Number Information
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NPI Number | 1699893230
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CHIROPRACTIC OF JASPER, PA
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 799 W. GIBSON STE 700
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City | JASPER
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State | TX
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Zip | 75948
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Country | US
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Telephone | 409-384-7776
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Fax | 409-384-7779
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Provider Business Mailing Address
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Address Line | 799 W. GIBSON STE 700
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City | JASPER
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State | TX
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Zip | 75948
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Country | US
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Telephone | 409-384-7776
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Fax | 409-384-7779
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIC LEE LANGFORD
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Credential | D.C.
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Telephone | 409-384-7776
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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 | DC6063
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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 | 11268
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11267
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License Number State | TX
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