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General NPI Number Information
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NPI Number | 1811109390
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CHIROPRACTIC & WELLNESS CENTER, PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 112 VALLEY ST
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City | LINDALE
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State | TX
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Zip | 75771-6493
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Country | US
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Telephone | 903-502-0407
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Fax | 903-865-5032
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Provider Business Mailing Address
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Address Line | PO BOX 7817
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City | TYLER
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State | TX
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Zip | 75711-7817
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Country | US
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Telephone | 903-502-0407
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Fax | 903-865-5032
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAREN AUSTIN
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Credential | DC
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Telephone | 903-520-1017
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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 | 9667
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License Number State | TX
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