Healthcare Provider Details

I. General information

NPI: 1013219617
Provider Name (Legal Business Name): DFW PIONEER ADC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 01/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W PIONEER PKWY
ARLINGTON TX
76013-7624
US

IV. Provider business mailing address

3200 SAN PAULA CT
ARLINGTON TX
76012
US

V. Phone/Fax

Practice location:
  • Phone: 817-459-3311
  • Fax: 817-459-3314
Mailing address:
  • Phone: 214-837-6950
  • Fax: 817-459-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYLE X MATTHIS
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 214-837-6950