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General NPI Number Information
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NPI Number | 1073899324
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Entity Type | Organization
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Legal Business Name | DEVOS CHIROPRACTIC P.A.
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 1959 W SOUTHLAKE BLVD SUITE 140
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6713
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Country | US
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Telephone | 972-989-1363
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Fax | 817-488-8927
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Provider Business Mailing Address
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Address Line | 304 KING RICHARD ST
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City | IRVING
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State | TX
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Zip | 75061-6427
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Country | US
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Telephone | 972-989-1363
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WIM DEVOS
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Credential | D.C.
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Telephone | 972-989-1363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 8031
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License Number State | TX
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