Provider Demographics
NPI:1053703777
Name:TEXAS CHIROSPORT, P.L.L.C.
Entity type:Organization
Organization Name:TEXAS CHIROSPORT, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ST. ONGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-444-8585
Mailing Address - Street 1:1121 KINWEST PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3124
Mailing Address - Country:US
Mailing Address - Phone:972-444-8585
Mailing Address - Fax:888-463-8877
Practice Address - Street 1:1121 KINWEST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3124
Practice Address - Country:US
Practice Address - Phone:972-444-8585
Practice Address - Fax:888-463-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty