Healthcare Provider Details

I. General information

NPI: 1629089032
Provider Name (Legal Business Name): DAVID MARK TRYLING LAC, D.AC,CH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 CENTRAL DR SUITE 155
BEDFORD TX
76021-6829
US

IV. Provider business mailing address

2816 CENTRAL DR SUITE 155
BEDFORD TX
76021-6829
US

V. Phone/Fax

Practice location:
  • Phone: 817-835-0885
  • Fax: 817-571-1885
Mailing address:
  • Phone: 817-835-0885
  • Fax: 817-571-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: