Healthcare Provider Details

I. General information

NPI: 1699039008
Provider Name (Legal Business Name): PCW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N GOLIAD ST
ROCKWALL TX
75087-2539
US

IV. Provider business mailing address

105 N GOLIAD ST
ROCKWALL TX
75087-2539
US

V. Phone/Fax

Practice location:
  • Phone: 972-961-0673
  • Fax:
Mailing address:
  • Phone: 972-961-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10822
License Number StateTX

VIII. Authorized Official

Name: JOE CHRISTOPHER MIGLIACCIO
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 214-529-5647