MEDICARE: DCMDPA

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	111NR0400X	Rehabilitation Chiropractor	5870	TX

General Provider Information

NPI Number	:	1366517815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DCMDPA

Provider Business Mailing Address
First Line	:	2306 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-8605
Country	:	US
Telephone Number	:	214-275-4124
Fax Number	:	214-275-4408

Provider Business Practice Location Address
First Line	:	2306 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-8605
Country	:	US
Telephone Number	:	214-275-4124
Fax Number	:	214-275-4408

Authorized Official
Title or Position	:	REPRESENTATIVE
Name	:	DR. MARSHA RAE MILLER
Credential	:	DC
Telephone Number	:	214-275-4124

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/15/2007

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Directions to “DCMDPA ” Practice Location

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