Healthcare Provider Details

I. General information

NPI: 1508458712
Provider Name (Legal Business Name): NXT LVL: SPORTS REHAB & PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LAKE CAROLYN PKWY APT 2334
IRVING TX
75039-3973
US

IV. Provider business mailing address

1050 LAKE CAROLYN PKWY APT 2334
IRVING TX
75039-3973
US

V. Phone/Fax

Practice location:
  • Phone: 210-843-4405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RUTH DAVIS
Title or Position: OWNER/CHIROPRACTOR
Credential: DC, ATC
Phone: 210-843-4405