Provider Demographics
NPI:1891542841
Name:AT HOME CHIROPRACTIC LLC
Entity type:Organization
Organization Name:AT HOME CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:979-224-8151
Mailing Address - Street 1:1618 W STATE HIGHWAY 71 # 526
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-5138
Mailing Address - Country:US
Mailing Address - Phone:979-224-8151
Mailing Address - Fax:
Practice Address - Street 1:1069 CR 200 ROAD
Practice Address - Street 2:
Practice Address - City:WEIMAR
Practice Address - State:TX
Practice Address - Zip Code:78962
Practice Address - Country:US
Practice Address - Phone:979-224-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty