NPIMap

Organization Active NPI

Kilgore Chiropractic Clinic Inc

  • Chiropractor
  • Kilgore, TX
National Provider Identifier
1821133638
Registry record updated Feb 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2872 Issued in TX
Legal business name
KILGORE CHIROPRACTIC CLINIC INC
Practice address
316 N Henderson Blvd
Kilgore, TX 75662-2712
Phone
(903) 984-4432
Fax
(903) 984-1023
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2011

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

Authorized official

Name
Dr. Charles Robert Cottier, DCNPI 1235159500
Title
Owner
Phone
(903) 984-4432

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2872 TX Primary

Addresses

Primary practice location

316 N Henderson Blvd
Kilgore, TX 75662-2712

Mailing address

316 N Henderson Blvd
Kilgore, TX 75662-2712
Phone (903) 984-4432

Other identifiers 3

IdentifierTypeStateIssuer
0025QUOtherTXBCBS
001199101MedicaidTX
350005434OtherTXRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110107000906 TX Part B Supplier - Clinic/Group Practice 4284823121 Receives reassigned benefits from 1 practitioner
Practice locations: Kilgore, TX

National Provider Directory

National Provider Directory

Locations

316 N Henderson Blvd
Kilgore, TX 75662
Phone (903) 984-2145

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": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297382400000",
    "number": "1821133638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 N HENDERSON BLVD",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756622712",
            "telephone_number": "903-984-4432",
            "fax_number": "903-984-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 N HENDERSON BLVD",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756622712",
            "telephone_number": "903-984-4432",
            "fax_number": "903-984-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILGORE CHIROPRACTIC CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2011-02-11",
        "status": "A",
        "authorized_official_last_name": "COTTIER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-984-4432",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "2872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0025QU",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001199101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350005434",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kilgore, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.