Healthcare Provider Details

I. General information

NPI: 1174753677
Provider Name (Legal Business Name): OCCUCARE MEDICAL CENTERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 JOHN W CARPENTER FWY SUITE 100
DALLAS TX
75247-4721
US

IV. Provider business mailing address

6789 CAMP BOWIE BLVD
FORT WORTH TX
76116-7112
US

V. Phone/Fax

Practice location:
  • Phone: 972-677-4895
  • Fax: 972-677-4896
Mailing address:
  • Phone: 817-731-2101
  • Fax: 817-731-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number9831
License Number StateTX

VIII. Authorized Official

Name: DR. JOE H YSBRAND
Title or Position: MEMBER
Credential: DC
Phone: 817-731-2102