Provider Demographics
NPI:1962717041
Name:HEALTHQUEST CHIROPRACTIC
Entity type:Organization
Organization Name:HEALTHQUEST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELLIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-926-7247
Mailing Address - Street 1:2221 CROSS TIMBERS RD STE 137
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7724
Mailing Address - Country:US
Mailing Address - Phone:972-724-7247
Mailing Address - Fax:
Practice Address - Street 1:2221 CROSS TIMBERS RD STE 137
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7724
Practice Address - Country:US
Practice Address - Phone:972-724-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7283111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605729Medicare PIN
TXU67202Medicare UPIN