MEDICARE: EAST TEXAS CHIROPRACTIC & WELLNESS CENTER, PA

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	9667	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	TX9667	OTHER	TX	TBCE
3	1255314266	OTHER	TX	PERSONAL NPI

General Provider Information

NPI Number	:	1811109390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST TEXAS CHIROPRACTIC & WELLNESS CENTER, PA

Provider Business Mailing Address
First Line	:	PO BOX 7817
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75711-7817
Country	:	US
Telephone Number	:	903-502-0407
Fax Number	:	903-865-5032

Provider Business Practice Location Address
First Line	:	112 VALLEY ST
Second Line	:
City	:	LINDALE
State	:	TX
Zip	:	75771-6493
Country	:	US
Telephone Number	:	903-502-0407
Fax Number	:	903-865-5032

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KAREN AUSTIN
Credential	:	DC
Telephone Number	:	903-520-1017

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	02/11/2021

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