MEDICARE: TEXARKANA GROUP, P.L.L.C

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

General Provider Information

NPI Number	:	1881064731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXARKANA GROUP, P.L.L.C

Provider Business Mailing Address
First Line	:	2100 N. STATE LINE AVE.
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854
Country	:	US
Telephone Number	:	870-779-1111
Fax Number	:	870-779-1115

Provider Business Practice Location Address
First Line	:	2100 N. STATE LINE AVE.
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854
Country	:	US
Telephone Number	:	870-779-1111
Fax Number	:	870-779-1115

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. CLAUDIA HAZAGA
Credential	:
Telephone Number	:	209-612-3677

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	10/05/2015

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