Healthcare Provider Details

I. General information

NPI: 1932257680
Provider Name (Legal Business Name): CHIROSPORT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 N HASKELL AVE
DALLAS TX
75204-3708
US

IV. Provider business mailing address

2406 N HASKELL AVE
DALLAS TX
75204-3708
US

V. Phone/Fax

Practice location:
  • Phone: 214-370-4509
  • Fax:
Mailing address:
  • Phone: 214-370-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number9933
License Number StateTX

VIII. Authorized Official

Name: DR. CHRIS MILLER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 214-370-4509