Provider Demographics
NPI:1285472837
Name:CORPORATE CHIRO LLC
Entity type:Organization
Organization Name:CORPORATE CHIRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-516-5960
Mailing Address - Street 1:PO BOX 1202
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77592-1202
Mailing Address - Country:US
Mailing Address - Phone:816-516-5960
Mailing Address - Fax:
Practice Address - Street 1:201 13TH AVE N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-6222
Practice Address - Country:US
Practice Address - Phone:816-516-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty