Healthcare Provider Details

I. General information

NPI: 1821237702
Provider Name (Legal Business Name): NICHOLAS J CANTRELLE D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W MOCKINGBIRD LN STE 1000
DALLAS TX
75247-5010
US

IV. Provider business mailing address

1111 W MOCKINGBIRD LN STE 1000
DALLAS TX
75247-5010
US

V. Phone/Fax

Practice location:
  • Phone: 214-920-9111
  • Fax: 214-920-9110
Mailing address:
  • Phone: 214-920-9111
  • Fax: 214-920-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: