Healthcare Provider Details

I. General information

NPI: 1427168970
Provider Name (Legal Business Name): CHIROSPORT SPECIALISTS OF DALLAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BELT LINE RD STE 100
DALLAS TX
75254-6751
US

IV. Provider business mailing address

4950 BELT LINE RD STE 100
DALLAS TX
75254-6751
US

V. Phone/Fax

Practice location:
  • Phone: 972-239-0010
  • Fax:
Mailing address:
  • Phone: 972-239-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number7351
License Number StateTX

VIII. Authorized Official

Name: TROY CURTIS VAN BIEZEN
Title or Position: CHIROPRACTOR
Credential: D.C., A.R.T., B.P.E.
Phone: 972-239-0010