Provider Demographics
NPI:1902081474
Name:ROCKWALL CHIROPRACTIC PA
Entity type:Organization
Organization Name:ROCKWALL CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-771-9844
Mailing Address - Street 1:1141 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4217
Mailing Address - Country:US
Mailing Address - Phone:972-771-9844
Mailing Address - Fax:972-771-4674
Practice Address - Street 1:1141 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4217
Practice Address - Country:US
Practice Address - Phone:972-771-9844
Practice Address - Fax:972-771-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9277111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU94528Medicare UPIN