MEDICARE: DENITO CHIROPRACTIC CLINIC, 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	2875	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265705438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENITO CHIROPRACTIC CLINIC, PC

Provider Business Mailing Address
First Line	:	408 N ALLEN DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-2500
Country	:	US
Telephone Number	:	972-727-8947
Fax Number	:	214-495-0891

Provider Business Practice Location Address
First Line	:	408 N ALLEN DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-2500
Country	:	US
Telephone Number	:	972-727-8947
Fax Number	:	214-495-0891

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES DENITO
Credential	:	D.C.
Telephone Number	:	972-727-8947

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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