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General NPI Number Information
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NPI Number | 1043547607
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Entity Type | Organization
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Legal Business Name | GENESIS SPINE ASSOCIATES, INC
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 07/14/2010
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Provider Practice Location Address
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Address Line | 901 W WALL ST STE 101
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City | GRAPEVINE
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State | TX
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Zip | 76051-7414
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Country | US
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Telephone | 817-481-4246
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 WINDCOM CT STE 300
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City | PLANO
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State | TX
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Zip | 75093-7817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICHOLAS COLEMAN
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Credential | D.C.
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Telephone | 972-378-9991
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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 |
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License Number State |
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