Healthcare Provider Details

I. General information

NPI: 1760393995
Provider Name (Legal Business Name): CHIROPRACTIC SPINE MANAGEMENT CENTER, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 COTTONWOOD LN STE 165
IRVING TX
75038-6117
US

IV. Provider business mailing address

1110 COTTONWOOD LN STE 165
IRVING TX
75038-6117
US

V. Phone/Fax

Practice location:
  • Phone: 469-978-9945
  • Fax: 817-662-4838
Mailing address:
  • Phone: 469-224-1500
  • Fax: 469-242-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEREK FARMEN
Title or Position: OWNER
Credential: DC
Phone: 469-978-9945