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NPI Code Detail

MEDICARE: MS. PHEOMANY VANDY D.C.

MEDICARE: MS. PHEOMANY VANDY D.C.
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
1111N00000XChiropractor10594TX

General Provider Information

NPI Number : 1316149990
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PHEOMANY VANDY D.C.
Provider Business Mailing Address
First Line : 4250 E RENNER RD APT 1827
Second Line :
City : RICHARDSON
State : TX
Zip : 75082-2853
Country : US
Telephone Number : 469-774-8193
Fax Number :
Provider Business Practice Location Address
First Line : 6148 BRYANT IRVIN RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4119
Country : US
Telephone Number : 817-292-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 07/08/2007

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Directions to “ MS. PHEOMANY VANDY D.C.” Practice Location

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