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General NPI Number Information
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NPI Number | 1104245422
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Entity Type | Organization
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Legal Business Name | THE BODY SHOP CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 4015 MAIN ST
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City | DALLAS
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State | TX
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Zip | 75226-1231
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Country | US
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Telephone | 469-334-0624
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Fax |
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Provider Business Mailing Address
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Address Line | 4015 MAIN ST
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City | DALLAS
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State | TX
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Zip | 75226-1231
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Country | US
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Telephone | 469-334-0624
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. JENNIFER KINNEAR
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Credential |
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Telephone | 469-334-0624
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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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