Healthcare Provider Details

I. General information

NPI: 1124456686
Provider Name (Legal Business Name): EZ CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 10/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 LAS COLINAS BLVD W STE 1650
IRVING TX
75039-5436
US

IV. Provider business mailing address

1809 FRANKLIN ST
IRVING TX
75060-5921
US

V. Phone/Fax

Practice location:
  • Phone: 817-821-0004
  • Fax:
Mailing address:
  • Phone: 214-600-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12455
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number12455
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number12455
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number12455
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number12455
License Number StateTX

VIII. Authorized Official

Name: DR. ARNALDO ANTONIO LOPEZ JR.
Title or Position: PRESIDENT
Credential: D.C.
Phone: 817-821-0004