MEDICARE: THRIVE CHIROPRACTIC PLLC

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	:	1629538921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	1417 S CENTER ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-2865
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 S CENTER ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-2865
Country	:	US
Telephone Number	:	817-861-5757
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR/OWNER
Name	:	MICHAEL MOSS
Credential	:
Telephone Number	:	404-590-9432

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	03/22/2019

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