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General NPI Number Information
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NPI Number | 1700293453
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Entity Type | Organization
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Legal Business Name | LAKE TEXOMA CHIROPRACTIC
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 81750 N STATE HWY 289 STE 102
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City | POTTSBORO
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State | TX
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Zip | 75076
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Country | US
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Telephone | 903-327-9166
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Fax | 888-886-8139
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Provider Business Mailing Address
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Address Line | 81750 N STATE HWY 289 STE 102
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City | POTTSBORO
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State | TX
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Zip | 75076-4966
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Country | US
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Telephone | 330-482-9350
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Fax | 330-482-2336
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NATALIE ANN BEIGHT
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Credential | DC
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Telephone | 903-327-9166
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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 | DC009315
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License Number State | PA
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