NPIMap

Organization Active NPI

East Texas Chiropractic of Jasper, PA

  • Chiropractor
  • Jasper, TX
National Provider Identifier
1699893230
Registry record updated Aug 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
11267 Issued in TX
Legal business name
EAST TEXAS CHIROPRACTIC OF JASPER, PA
Practice address
799 W. Gibson
Ste 700
Jasper, TX 75948
Phone
(409) 384-7776
Fax
(409) 384-7779
NPI assigned
Mar 26, 2007
Last updated
Aug 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2012

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

Authorized official

Name
Dr. Bric Lee Langford, D.C.NPI 1124351820
Title
Owner
Phone
(409) 384-7776

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X DC6063 TX
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 11267 TX Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 11268 TX

Addresses

Primary practice location

799 W. Gibson
Ste 700
Jasper, TX 75948

Mailing address

799 W. Gibson
Ste 700
Jasper, TX 75948
Phone (409) 384-7776

Other identifiers 2

IdentifierTypeStateIssuer
DC6063OtherTXSTATE LICENSE NUMBER
0884470-01MedicaidTX

Other names 1

  • Michael T. Fleck DC PA Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070806000758 TX Part B Supplier - Clinic/Group Practice 1951492990 Receives reassigned benefits from 1 practitioner
Practice locations: Jasper, TX

National Provider Directory

National Provider Directory

Locations

799 W Gibson St
Ste 700
Jasper, TX 75951
Phone (409) 384-7776

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1699893230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "799 W. GIBSON",
            "address_2": "STE 700",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "75948",
            "telephone_number": "409-384-7776",
            "fax_number": "409-384-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 W. GIBSON",
            "address_2": "STE 700",
            "city": "JASPER",
            "state": "TX",
            "postal_code": "75948",
            "telephone_number": "409-384-7776",
            "fax_number": "409-384-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS CHIROPRACTIC OF JASPER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "LANGFORD",
        "authorized_official_first_name": "BRIC",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "409-384-7776",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "DC6063",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "11267",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "11268",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "DC6063",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0884470-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael T. Fleck DC PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jasper, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; 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.