Healthcare Provider Details

I. General information

NPI: 1932382819
Provider Name (Legal Business Name): STEPHEN ORWIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 S MAIN ST
IRVING TX
75060-2926
US

IV. Provider business mailing address

139 S MAIN ST
IRVING TX
75060-2926
US

V. Phone/Fax

Practice location:
  • Phone: 972-259-4878
  • Fax: 972-259-2968
Mailing address:
  • Phone: 972-259-4878
  • Fax: 972-259-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number6242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: