Healthcare Provider Details

I. General information

NPI: 1205007838
Provider Name (Legal Business Name): SANVAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 S GREAT SOUTHWEST PKWY 505
GRAND PRAIRIE TX
75051-7417
US

IV. Provider business mailing address

2133 S GREAT SOUTHWEST PKWY 505
GRAND PRAIRIE TX
75051-7417
US

V. Phone/Fax

Practice location:
  • Phone: 972-647-2400
  • Fax: 972-623-3400
Mailing address:
  • Phone: 972-647-2400
  • Fax: 972-623-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8992
License Number StateTX

VIII. Authorized Official

Name: MR. JORGE RENE SANCHEZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 972-647-2400