Provider Demographics
NPI:1396883724
Name:AGRITELLEY INC.
Entity type:Organization
Organization Name:AGRITELLEY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:EBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-916-1592
Mailing Address - Street 1:6060 DILBECK LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5351
Mailing Address - Country:US
Mailing Address - Phone:469-916-1592
Mailing Address - Fax:972-458-6829
Practice Address - Street 1:6060 DILBECK LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5351
Practice Address - Country:US
Practice Address - Phone:469-916-1592
Practice Address - Fax:972-458-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10258111N00000X
TX1153020225100000X
TX9065111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K8669OtherBCBS