MEDICARE: HORIZON CHIROPRACTIC AND WELLNESS CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1154543395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON CHIROPRACTIC AND WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	5609 SW GREEN OAKS BLVD STE 104
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017
Country	:	US
Telephone Number	:	817-478-8700
Fax Number	:	817-478-8405

Provider Business Practice Location Address
First Line	:	5609 SW GREEN OAKS BLVD STE 104
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1153
Country	:	US
Telephone Number	:	817-478-8700
Fax Number	:	817-478-8405

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DOUGLAS CARL PENDERGRASS
Credential	:	D.O.
Telephone Number	:	817-478-8700

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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