Provider Demographics
NPI:1992979918
Name:PROCHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:PROCHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-297-2400
Mailing Address - Street 1:1012 S CROWLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036
Mailing Address - Country:US
Mailing Address - Phone:817-297-2400
Mailing Address - Fax:817-297-2400
Practice Address - Street 1:1012 S CROWLEY RD STE B
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036
Practice Address - Country:US
Practice Address - Phone:817-297-2400
Practice Address - Fax:817-297-2400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTY3530Medicare UPIN