Healthcare Provider Details

I. General information

NPI: 1639992423
Provider Name (Legal Business Name): DECOMPRESS CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S SHADY SHORES DR STE 100
LAKE DALLAS TX
75065-3609
US

IV. Provider business mailing address

314 S SHADY SHORES DR STE 100
LAKE DALLAS TX
75065-3609
US

V. Phone/Fax

Practice location:
  • Phone: 940-363-1039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PARKER TOLIVER
Title or Position: OWNER
Credential: DC
Phone: 940-363-1039