Healthcare Provider Details

I. General information

NPI: 1336290501
Provider Name (Legal Business Name): BOBBY CARROLL ERWIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 COOPER ST
MELISSA TX
75454-9542
US

IV. Provider business mailing address

PO BOX 125
MELISSA TX
75454-0125
US

V. Phone/Fax

Practice location:
  • Phone: 972-838-2992
  • Fax: 972-838-2961
Mailing address:
  • Phone: 972-838-2992
  • Fax: 972-838-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5901
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: