Healthcare Provider Details

I. General information

NPI: 1841460441
Provider Name (Legal Business Name): NORTH DALLAS INTEGRATED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14444 DALLAS PKWY SUITE 115
DALLAS TX
75254-8304
US

IV. Provider business mailing address

14444 DALLAS PKWY SUITE 115
DALLAS TX
75254-8304
US

V. Phone/Fax

Practice location:
  • Phone: 972-789-1234
  • Fax: 972-789-1589
Mailing address:
  • Phone: 972-789-1234
  • Fax: 972-789-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6457
License Number StateTX

VIII. Authorized Official

Name: GARY MARTIN
Title or Position: OWNER
Credential: DC
Phone: 972-789-1234