Healthcare Provider Details

I. General information

NPI: 1326569880
Provider Name (Legal Business Name): HEALTH RESOURCES AND REHAB CHIROPRACTIC WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N SAINT PAUL ST STE 200
DALLAS TX
75201-6804
US

IV. Provider business mailing address

PO BOX 225843
DALLAS TX
75222-5843
US

V. Phone/Fax

Practice location:
  • Phone: 832-725-7406
  • Fax: 800-381-9202
Mailing address:
  • Phone: 832-725-7406
  • Fax: 800-381-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4488
License Number StateTX

VIII. Authorized Official

Name: DR. JACQUELINE D. MOORE-EVANS
Title or Position: CHIROPRACTIC
Credential: DC
Phone: 832-725-7406