Healthcare Provider Details

I. General information

NPI: 1043630072
Provider Name (Legal Business Name): ACCIDENT & INJURY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N TOWN EAST BLVD
MESQUITE TX
75150-4157
US

IV. Provider business mailing address

200 WYNNEWOOD VILLAGE
DALLAS TX
75224
US

V. Phone/Fax

Practice location:
  • Phone: 972-279-7246
  • Fax: 972-279-0955
Mailing address:
  • Phone: 214-946-7246
  • Fax: 214-946-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number12386
License Number StateTX

VIII. Authorized Official

Name: DR. VANIECEA L DUNCAN
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 972-279-7246