MEDICARE: TARRANT INJURY AND REHAB

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	7883	TX

General Provider Information

NPI Number	:	1154644649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRANT INJURY AND REHAB

Provider Business Mailing Address
First Line	:	170 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-5008
Country	:	US
Telephone Number	:	817-615-8200
Fax Number	:	817-615-8203

Provider Business Practice Location Address
First Line	:	170 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-5008
Country	:	US
Telephone Number	:	817-615-8200
Fax Number	:	817-615-8203

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MR. MARK SANEMAN
Credential	:	D.C
Telephone Number	:	817-615-8200

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	03/11/2010

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