Healthcare Provider Details

I. General information

NPI: 1497953988
Provider Name (Legal Business Name): DAVID BACK CLINIC OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 HULEN ST #110
FORT WORTH TX
76107-7276
US

IV. Provider business mailing address

3800 HULEN ST #110
FORT WORTH TX
76107-7276
US

V. Phone/Fax

Practice location:
  • Phone: 817-921-9983
  • Fax: 817-763-9985
Mailing address:
  • Phone: 817-921-9983
  • Fax: 817-763-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE6117
License Number StateTX

VIII. Authorized Official

Name: BOB SCHLINKMAN
Title or Position: PARTNER -VP NATIONAL DEVELOPMENT
Credential: D.C.
Phone: 972-839-3250