Provider Demographics
NPI:1396372702
Name:SPECIFIC CLINIC OF CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SPECIFIC CLINIC OF CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEAN
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:939-865-8111
Mailing Address - Street 1:204 PALOMA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-2211
Mailing Address - Country:US
Mailing Address - Phone:254-958-2677
Mailing Address - Fax:
Practice Address - Street 1:204 PALOMA DR STE 110
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2211
Practice Address - Country:US
Practice Address - Phone:254-958-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty