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General NPI Number Information
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NPI Number | 1114023934
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Entity Type | Individual
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Provider Name | MARENTHA S COFFEE DC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 14330 MIDWAY RD SUITE 116
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City | DALLAS
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State | TX
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Zip | 75244-3522
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Country | US
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Telephone | 469-547-1173
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Fax | 469-629-5007
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Provider Business Mailing Address
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Address Line | 14330 MIDWAY RD SUITE 116
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City | DALLAS
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State | TX
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Zip | 75244-3522
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Country | US
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Telephone | 469-547-1173
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Fax | 469-629-5007
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 9622
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License Number State | TX
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