Provider Demographics
NPI:1871361881
Name:FLOW STATE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FLOW STATE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POTSAWAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMHAENG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-581-2224
Mailing Address - Street 1:11929 VIENNA APPLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-7582
Mailing Address - Country:US
Mailing Address - Phone:516-581-2224
Mailing Address - Fax:
Practice Address - Street 1:4611 PRESTON RD STE 150
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7601
Practice Address - Country:US
Practice Address - Phone:469-200-5046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center