Healthcare Provider Details

I. General information

NPI: 1104276062
Provider Name (Legal Business Name): DAVID KIRK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 W ILLINOIS AVE STE 118
DALLAS TX
75211-8797
US

IV. Provider business mailing address

5747 REMINGTON PARK SQ
DALLAS TX
75252-5395
US

V. Phone/Fax

Practice location:
  • Phone: 214-339-9111
  • Fax: 214-339-9118
Mailing address:
  • Phone: 404-798-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: