Healthcare Provider Details

I. General information

NPI: 1578760617
Provider Name (Legal Business Name): INJURY CARE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 HARRY HINES BLVD SUITE 218
DALLAS TX
75235-5387
US

IV. Provider business mailing address

PO BOX 542581
DALLAS TX
75354-2581
US

V. Phone/Fax

Practice location:
  • Phone: 972-701-8181
  • Fax: 972-701-8182
Mailing address:
  • Phone: 972-701-8181
  • Fax: 972-701-8182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9455
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberJ3024
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9504
License Number StateTX

VIII. Authorized Official

Name: ELHAM KAIVAN-MEHR
Title or Position: ASSOCIATE
Credential: DC
Phone: 972-701-8181