Healthcare Provider Details

I. General information

NPI: 1073079638
Provider Name (Legal Business Name): EDWARD AMADI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 REGAL ROW STE 100
DALLAS TX
75247-5213
US

IV. Provider business mailing address

8 MEDICAL PKWY STE 208
DALLAS TX
75234-7842
US

V. Phone/Fax

Practice location:
  • Phone: 972-701-8181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: