MEDICARE: DAGENHART HOLDINGS INCORPORATED

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

General Provider Information

NPI Number	:	1477283893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAGENHART HOLDINGS INCORPORATED

Provider Business Mailing Address
First Line	:	26077 NELSON WAY
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-5642
Country	:	US
Telephone Number	:	832-479-9558
Fax Number	:

Provider Business Practice Location Address
First Line	:	26077 NELSON WAY
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-5642
Country	:	US
Telephone Number	:	832-479-9558
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TOBY DAGENHART
Credential	:
Telephone Number	:	832-479-9558

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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