Healthcare Provider Details

I. General information

NPI: 1720282122
Provider Name (Legal Business Name): DAVID BACK CLINIC OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7148 TRAIL LAKE DR
FORT WORTH TX
76123-1969
US

IV. Provider business mailing address

7148 TRAIL LAKE DR
FORT WORTH TX
76123-1969
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 TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number
License Number State

VIII. Authorized Official

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