Healthcare Provider Details

I. General information

NPI: 1235639204
Provider Name (Legal Business Name): TBI CENTERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 LANCASTER DR STE 240
GRAPEVINE TX
76051-3586
US

IV. Provider business mailing address

391 LAS COLINAS BLVD E # 130937
IRVING TX
75039-6291
US

V. Phone/Fax

Practice location:
  • Phone: 817-328-0349
  • Fax: 972-852-9140
Mailing address:
  • Phone: 817-328-0349
  • Fax: 972-852-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK1232
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number06478
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberP4641
License Number StateTX

VIII. Authorized Official

Name: DR. ALOK KUSHWAHA
Title or Position: MANAGER
Credential: MD
Phone: 817-235-9665