Provider Demographics
NPI:1285874974
Name:LEGEND CHIROPRACTIC PC
Entity type:Organization
Organization Name:LEGEND CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-759-2225
Mailing Address - Street 1:401 ED SCHMIDT BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5714
Mailing Address - Country:US
Mailing Address - Phone:512-759-2225
Mailing Address - Fax:866-693-6331
Practice Address - Street 1:401 ED SCHMIDT BLVD
Practice Address - Street 2:STE 500
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5714
Practice Address - Country:US
Practice Address - Phone:512-759-2225
Practice Address - Fax:866-693-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty