Provider Demographics
NPI:1336537240
Name:ELDER CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:ELDER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENSON
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:STRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:D,C,
Authorized Official - Phone:903-759-5557
Mailing Address - Street 1:1809 W LOOP 281
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2571
Mailing Address - Country:US
Mailing Address - Phone:903-759-5557
Mailing Address - Fax:903-297-3506
Practice Address - Street 1:1809 W LOOP 281
Practice Address - Street 2:SUITE 104
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2571
Practice Address - Country:US
Practice Address - Phone:903-759-5557
Practice Address - Fax:903-297-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU95941Medicare UPIN