MEDICARE: SALANCE CLINIC, INC.

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	10934	TX

General Provider Information

NPI Number	:	1437483831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALANCE CLINIC, INC.

Provider Business Mailing Address
First Line	:	4255 BRYANT IRVIN RD STE 108
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4224
Country	:	US
Telephone Number	:	817-731-4848
Fax Number	:	817-731-4858

Provider Business Practice Location Address
First Line	:	4255 BRYANT IRVIN RD STE 108
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4224
Country	:	US
Telephone Number	:	817-731-4848
Fax Number	:	817-731-4858

Authorized Official
Title or Position	:	OWNER/OFFICE PRESIDENT
Name	:	ATHENA MARIE PAYNE
Credential	:	D.C.
Telephone Number	:	817-731-4848

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	05/30/2017

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Directions to “SALANCE CLINIC, INC. ” Practice Location

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