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General NPI Number Information
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NPI Number | 1013017987
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Entity Type | Organization
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Legal Business Name | NORTH DALLAS ADVANCED DIAGNOSTIC PA
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 1705 OHIO DR SUITE 200 A
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City | PLANO
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State | TX
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Zip | 75093-5255
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Country | US
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Telephone | 866-620-5987
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Fax | 866-818-2129
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Provider Business Mailing Address
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Address Line | PO BOX 703324
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City | DALLAS
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State | TX
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Zip | 75370-3324
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Country | US
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Telephone | 580-276-3320
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Fax | 580-276-3321
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Authorized Official
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Title or Position | OWNER
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Name | DR. REZA ASSADOLLAHI
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Credential | D.C.
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Telephone | 866-620-5987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 07107
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License Number State | TX
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