MEDICARE: JOHNS FAMILY CHIROPRACTIC CORP

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
1	111N00000X	Chiropractor	9359	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00199466	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8S3180	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1427155068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNS FAMILY CHIROPRACTIC CORP

Provider Business Mailing Address
First Line	:	3316 RICHMOND RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-0703
Country	:	US
Telephone Number	:	866-933-1381
Fax Number	:	972-704-2886

Provider Business Practice Location Address
First Line	:	3316 RICHMOND RD
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-0703
Country	:	US
Telephone Number	:	866-933-1381
Fax Number	:	972-704-2886

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	JACQUE KEIL
Credential	:
Telephone Number	:	866-933-1381

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	01/26/2012

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