MEDICARE: ST ONGE CHIROPRACTIC & SPORTS THERAPY

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	10070	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TXB164587	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1790944809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST ONGE CHIROPRACTIC & SPORTS THERAPY

Provider Business Mailing Address
First Line	:	1121 KINWEST PKWY
Second Line	:	100
City	:	IRVING
State	:	TX
Zip	:	75063-3135
Country	:	US
Telephone Number	:	972-444-8585
Fax Number	:	888-463-8877

Provider Business Practice Location Address
First Line	:	1121 KINWEST PKWY
Second Line	:	100
City	:	IRVING
State	:	TX
Zip	:	75063-3135
Country	:	US
Telephone Number	:	972-444-8585
Fax Number	:	888-463-8877

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY ST ONGE
Credential	:
Telephone Number	:	972-444-8585

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	02/26/2015

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Directions to “ST ONGE CHIROPRACTIC & SPORTS THERAPY ” Practice Location

Language	Start Address	Practice Location

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