Provider Demographics
NPI:1215253976
Name:SOUTHFORK CHIROPRACTIC
Entity type:Organization
Organization Name:SOUTHFORK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-578-2225
Mailing Address - Street 1:517 W FM 544
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4621
Mailing Address - Country:US
Mailing Address - Phone:972-578-2225
Mailing Address - Fax:972-578-2201
Practice Address - Street 1:517 W FM 544
Practice Address - Street 2:SUITE 200
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4621
Practice Address - Country:US
Practice Address - Phone:972-578-2225
Practice Address - Fax:972-578-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty