Basic Information
| Provider Information | |||||||||
| NPI: | 1013235019 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | A & M CHIROPRACTIC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 170156 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760030156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175720072 | ||||||||
| FaxNumber: | 8174782212 | ||||||||
| Practice Location | |||||||||
| Address1: | 4012 SW GREEN OAKS BLVD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760174113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175720072 | ||||||||
| FaxNumber: | 8174782212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2010 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | MILNE | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | TERESA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8175720072 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | 5279 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Sports Physician |
ID Information
| ID | Type | State | Issuer | Description | 605588 | 01 | TX | MEDICARE ID | OTHER |