Organization Active NPI

Magnolia Chiropractic, P.a.

  • Chiropractor
  • Irving, TX
National Provider Identifier
1104837756
Registry record updated Apr 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
MAGNOLIA CHIROPRACTIC, P.A.
Practice address
139 S Main St
Irving, TX 75060-2926
Phone
(972) 554-1511
Fax
(972) 554-1513
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacque Keil
Title
Billing Manager
Phone
(817) 557-2982

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

139 S Main St
Irving, TX 75060-2926

Mailing address

139 S Main St
Irving, TX 75060-2926
Phone (972) 554-1511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050426000385 TX Part B Supplier - Clinic/Group Practice 7315986791 Receives reassigned benefits from 1 practitioner
Practice locations: Irving, TX

National Provider Directory

National Provider Directory

Locations

1430 N MacArthur Blvd
Ste 104
Irving, TX 75061
Phone (972) 554-1511

139 S Main St
Irving, TX 75060
Phone (972) 554-1511

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303862400000",
    "number": "1104837756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 S MAIN ST",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750602926",
            "telephone_number": "972-554-1511",
            "fax_number": "972-554-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 S MAIN ST",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750602926",
            "telephone_number": "972-554-1511",
            "fax_number": "972-554-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA CHIROPRACTIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2011-04-27",
        "status": "A",
        "authorized_official_last_name": "KEIL",
        "authorized_official_first_name": "JACQUE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "817-557-2982"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irving, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.