Provider Demographics
NPI:1316240229
Name:CORRECTIVE CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DEGENHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-698-1600
Mailing Address - Street 1:560 E CENTRAL TEXAS EXPWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5606
Mailing Address - Country:US
Mailing Address - Phone:254-698-1600
Mailing Address - Fax:254-698-1605
Practice Address - Street 1:560 E CENTRAL TEXAS EXPWY
Practice Address - Street 2:SUITE 102
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5606
Practice Address - Country:US
Practice Address - Phone:254-698-1600
Practice Address - Fax:254-698-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0294Medicare UPIN