Healthcare Provider Details

I. General information

NPI: 1720247844
Provider Name (Legal Business Name): DAVID BACK CLINIC OF AMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

3725 COCKRELL AVE
FORT WORTH TX
76110-4602
US

V. Phone/Fax

Practice location:
  • Phone: 817-921-9983
  • Fax: 817-763-9985
Mailing address:
  • Phone: 817-921-9981
  • Fax: 817-921-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. CARMA ANDERSON
Title or Position: VP OPERATIONS
Credential:
Phone: 817-921-9981