Provider Demographics
NPI:1962949743
Name:ALPHA CHIRO SPORTS, LLC
Entity type:Organization
Organization Name:ALPHA CHIRO SPORTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUMGUARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:325-660-3266
Mailing Address - Street 1:650 WILLIAM D FITCH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7452
Mailing Address - Country:US
Mailing Address - Phone:979-398-2787
Mailing Address - Fax:
Practice Address - Street 1:650 WILLIAM D FITCH PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7452
Practice Address - Country:US
Practice Address - Phone:979-398-2787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13391111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX563761Medicare PIN