Healthcare Provider Details

I. General information

NPI: 1023829488
Provider Name (Legal Business Name): GREENVILLE AVENUE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/25/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 GREENVILLE AVE STE 904
DALLAS TX
75231-3834
US

IV. Provider business mailing address

7515 GREENVILLE AVE STE 904
DALLAS TX
75231-3834
US

V. Phone/Fax

Practice location:
  • Phone: 214-823-1323
  • Fax: 241-823-1035
Mailing address:
  • Phone: 214-823-1323
  • Fax: 241-823-1035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: EILEEN PSENCIK
Title or Position: OWNER
Credential: DC
Phone: 214-823-1323