Provider Demographics
NPI:1699941476
Name:AMARILLO FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:AMARILLO FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-379-8004
Mailing Address - Street 1:1005 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-3231
Mailing Address - Country:US
Mailing Address - Phone:806-379-8004
Mailing Address - Fax:806-379-7639
Practice Address - Street 1:1005 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-3231
Practice Address - Country:US
Practice Address - Phone:806-379-8004
Practice Address - Fax:806-379-7639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5247261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015166-01Medicaid
TX603170Medicare PIN
TX0015166-01Medicaid