Provider Demographics
NPI:1053554907
Name:BAY COLONY CHIROPRACTIC
Entity type:Organization
Organization Name:BAY COLONY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:RICANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-337-3337
Mailing Address - Street 1:350 FM 517 RD W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4010
Mailing Address - Country:US
Mailing Address - Phone:281-337-3337
Mailing Address - Fax:281-337-3336
Practice Address - Street 1:350 FM 517 RD W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4010
Practice Address - Country:US
Practice Address - Phone:281-337-3337
Practice Address - Fax:281-337-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8763111N00000X
TX5625111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty