Healthcare Provider Details

I. General information

NPI: 1285108274
Provider Name (Legal Business Name): NICOLE MARIE HORNAK DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
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: 972-557-7000
  • Fax: 972-557-7001
Mailing address:
  • Phone: 972-701-8181
  • Fax: 972-701-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number13924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: