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General NPI Number Information
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NPI Number | 1891542841
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Entity Type | Organization
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Legal Business Name | AT HOME CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/06/2024
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1069 CR 200 ROAD
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City | WEIMAR
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State | TX
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Zip | 78962
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Country | US
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Telephone | 979-224-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 W STATE HIGHWAY 71 # 526
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City | LA GRANGE
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State | TX
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Zip | 78945-5138
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Country | US
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Telephone | 979-224-8151
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DUWAYNE GARDNER
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Credential | DC
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Telephone | 979-224-8151
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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 |
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License Number State |
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