Provider Demographics
NPI:1427336932
Name:KABETZKE CHIROPRACTIC INC.
Entity type:Organization
Organization Name:KABETZKE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KABETZKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-602-7222
Mailing Address - Street 1:2426 S CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3805
Mailing Address - Country:US
Mailing Address - Phone:972-602-7222
Mailing Address - Fax:972-602-7223
Practice Address - Street 1:2426 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3805
Practice Address - Country:US
Practice Address - Phone:972-602-7222
Practice Address - Fax:972-602-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5972261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service