Organization
B.C.C. INC.APCC
Active
Other names
BACK PAIN CHIROPRACTIC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRI W BLOUIN (INSURANCE SUPERVISOR)
(985) 653-8903
Entity
Organization
Contact information
Practice address
3801 N STATE LINE AVE, TEXARKANA, TX 75503-3132
(903) 792-3763
(903) 792-6898
Mailing address
900 W AIRLINE HWY, LA PLACE, LA 70068-3816
(985) 653-8903
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
7000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1217457-03
—
TX
01
—
128823718
AR MEDICAID
AR
01
—
91929
AR BLUE CROO
AR
Enumeration date
03/29/2007
Last updated
06/20/2012
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