Healthcare Provider Details

I. General information

NPI: 1205933231
Provider Name (Legal Business Name): NEW LIFE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 LONG PRAIRIE RD SUITE 105
FLOWER MOUND TX
75022-4839
US

IV. Provider business mailing address

2628 LONG PRAIRIE RD SUITE 105
FLOWER MOUND TX
75022-4839
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-8002
  • Fax: 972-899-8003
Mailing address:
  • Phone: 972-899-8002
  • Fax: 972-899-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11117
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number6315
License Number StateTX

VIII. Authorized Official

Name: TIFFANY L MCCOY-MOORE
Title or Position: OWNER/CHIROPRACTOR
Credential: D.A.C.B.R.
Phone: 972-899-8002