Basic Information
| Provider Information | |||||||||
| NPI: | 1639473614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACTION CHIROPRACTIC CLINIC PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 PINE ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796013043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256761624 | ||||||||
| FaxNumber: | 3256768831 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 PINE ST | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796013043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256761624 | ||||||||
| FaxNumber: | 3256768831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2011 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | COLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 3256761624 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5177 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.