Provider Demographics
NPI:1194962373
Name:DR. ANDY CHIROPRACTIC
Entity type:Organization
Organization Name:DR. ANDY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOUNSAVATH
Authorized Official - Middle Name:ANDY
Authorized Official - Last Name:PHILACHACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-272-7788
Mailing Address - Street 1:2334 W BUCKINGHAM RD STE 360
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-3940
Mailing Address - Country:US
Mailing Address - Phone:972-272-7788
Mailing Address - Fax:972-272-0088
Practice Address - Street 1:2334 W BUCKINGHAM RD STE 360
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3940
Practice Address - Country:US
Practice Address - Phone:972-272-7788
Practice Address - Fax:972-272-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069EVOtherBLUE CROSS BLUE SHIELD