Provider Demographics
NPI:1255881728
Name:WAXAHACHIE CHIROPRACTIC
Entity type:Organization
Organization Name:WAXAHACHIE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-937-3100
Mailing Address - Street 1:1795 N HIGHWAY 77 STE 104
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-7868
Mailing Address - Country:US
Mailing Address - Phone:972-937-3100
Mailing Address - Fax:
Practice Address - Street 1:1795 N HIGHWAY 77 STE 104
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-7868
Practice Address - Country:US
Practice Address - Phone:972-937-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2016-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty