Healthcare Provider Details

I. General information

NPI: 1063654689
Provider Name (Legal Business Name): FIBROMYALGIS AND CHRONIC PAIN ASSOCS.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 03/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 HOFFMAN DR
DUBLIN TX
76446-1120
US

IV. Provider business mailing address

402 HOFFMAN DR
DUBLIN TX
76446-1120
US

V. Phone/Fax

Practice location:
  • Phone: 254-445-2404
  • Fax:
Mailing address:
  • Phone: 254-445-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberDC2405
License Number StateTX

VIII. Authorized Official

Name: DR. RONNIE R HUSE
Title or Position: CEO
Credential: DC
Phone: 254-445-2404