Healthcare Provider Details

I. General information

NPI: 1144576752
Provider Name (Legal Business Name): ADVANCED CHIROSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W FM 544 STE 200
MURPHY TX
75094-4577
US

IV. Provider business mailing address

345 W FM 544 STE 200
MURPHY TX
75094-4577
US

V. Phone/Fax

Practice location:
  • Phone: 972-578-2225
  • Fax: 972-578-2201
Mailing address:
  • Phone: 972-578-2225
  • Fax: 972-578-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NEIL DUKES
Title or Position: CEO/PRESIDENT
Credential: D.C.
Phone: 972-578-2225