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General NPI Number Information
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NPI Number | 1104244003
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Entity Type | Organization
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Legal Business Name | 100 PERCENT CHIROPRACTIC DALLAS ONE LLC
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 7324 GASTON AVE SUITE 118
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City | DALLAS
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State | TX
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Zip | 75214
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Country | US
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Telephone | 281-467-5381
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Fax |
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Provider Business Mailing Address
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Address Line | 7324 GASTON AVE # 118
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City | DALLAS
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State | TX
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Zip | 75214-6126
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Country | US
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Telephone | 214-812-9906
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Fax |
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Authorized Official
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Title or Position | DC
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Name | MICHAEL JAMES CARR
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Credential | D.C.
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Telephone | 214-812-9906
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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 | 0007106
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 12011
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License Number State | TX
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