Healthcare Provider Details

I. General information

NPI: 1639496920
Provider Name (Legal Business Name): INNOVATIVE PAIN SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10935 ESTATE LN SUITE 444
DALLAS TX
75238-2316
US

IV. Provider business mailing address

10935 ESTATE LN SUITE 444
DALLAS TX
75238-2316
US

V. Phone/Fax

Practice location:
  • Phone: 214-221-0685
  • Fax: 972-692-5772
Mailing address:
  • Phone: 214-221-0685
  • Fax: 972-692-5772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2-2630
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number6788
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE8702
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHEN M TAYLOR
Title or Position: ADMINISTRATOR
Credential: DC
Phone: 214-221-0685