Provider Demographics
NPI:1366560575
Name:INGRAM HEALTH CARE, P.C.
Entity type:Organization
Organization Name:INGRAM HEALTH CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOFER
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-567-5579
Mailing Address - Street 1:921 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-1009
Mailing Address - Country:US
Mailing Address - Phone:903-567-5579
Mailing Address - Fax:903-567-5938
Practice Address - Street 1:921 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-1009
Practice Address - Country:US
Practice Address - Phone:903-567-5579
Practice Address - Fax:903-567-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87390YOtherBC BS
TX$$$$$$$$$OtherSSN
TX$$$$$$$$$OtherSSN
TX87391YOtherBC BS
TXU55634Medicare UPIN
TX8D4372Medicare ID - Type Unspecified