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Organization
KILGORE CHIROPRACTIC CLINIC INC
Active
Organization
KILGORE CHIROPRACTIC CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ROBERT COTTIER DC (OWNER)
(903) 984-4432
Entity
Organization
Contact information
Practice address
316 N HENDERSON BLVD, KILGORE, TX 75662-2712
(903) 984-4432
(903) 984-1023
Mailing address
316 N HENDERSON BLVD, KILGORE, TX 75662-2712
(903) 984-4432
(903) 984-1023
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2872
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001199101
—
TX
01
—
0025QU
BCBS
TX
01
—
350005434
RAILROAD MEDICARE
TX
Enumeration date
02/20/2007
Last updated
02/11/2011
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