Provider Demographics
NPI:1487954343
Name:CASPER SPORT CHIROPRACTIC & SPINE INC
Entity type:Organization
Organization Name:CASPER SPORT CHIROPRACTIC & SPINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-375-0235
Mailing Address - Street 1:701 HIGHLANDER BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4600
Mailing Address - Country:US
Mailing Address - Phone:817-375-0235
Mailing Address - Fax:817-375-0281
Practice Address - Street 1:701 HIGHLANDER BLVD
Practice Address - Street 2:STE 150
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4600
Practice Address - Country:US
Practice Address - Phone:817-375-0235
Practice Address - Fax:817-375-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8340111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB120661Medicare PIN
TX6476400001Medicare NSC