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NPI Code Detail

MEDICARE: ISDALE CORRECTIVE CHIROPRACTIC

MEDICARE: ISDALE CORRECTIVE CHIROPRACTIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor2385TX

General Provider Information

NPI Number : 1417148701
Entity Type Code : Organization
Provider Name (Legal Business Name) : ISDALE CORRECTIVE CHIROPRACTIC
Provider Business Mailing Address
First Line : 716 INDIAN TRL STE 120
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-5702
Country : US
Telephone Number : 254-698-1600
Fax Number : 254-698-1605
Provider Business Practice Location Address
First Line : 716 INDIAN TRL STE 120
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-5702
Country : US
Telephone Number : 254-698-1600
Fax Number : 254-698-1605
Authorized Official
Title or Position : OWNER
Name : DR. SCOTT EDWARD ISDALE
Credential : D.C.
Telephone Number : 254-699-4004
Provider Enumeration Date : 08/05/2007
Last Update Date : 08/05/2007

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Directions to “ISDALE CORRECTIVE CHIROPRACTIC ” Practice Location

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