Healthcare Provider Details

I. General information

NPI: 1235185216
Provider Name (Legal Business Name): SANDY LAKE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 E SANDY LAKE RD SUITE 110
COPPELL TX
75019-5786
US

IV. Provider business mailing address

546 E SANDY LAKE RD SUITE 110
COPPELL TX
75019-5786
US

V. Phone/Fax

Practice location:
  • Phone: 972-393-8067
  • Fax: 972-393-6959
Mailing address:
  • Phone: 972-393-8067
  • Fax: 972-393-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6769
License Number StateTX

VIII. Authorized Official

Name: DR. MICHAEL J SCHNAPPAUF
Title or Position: OWNER/DIRECTOR
Credential: D.C.
Phone: 972-393-8067