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General NPI Number Information
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NPI Number | 1154514230
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Entity Type | Organization
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Legal Business Name | GENESIS FAMILY CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 12222 MERIT DR STE 340
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City | DALLAS
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State | TX
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Zip | 75251-2217
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Country | US
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Telephone | 972-378-9991
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Fax | 972-378-9992
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Provider Business Mailing Address
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Address Line | 12222 MERIT DR STE 340
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City | DALLAS
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State | TX
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Zip | 75251-2217
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Country | US
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Telephone | 972-378-9991
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Fax | 972-378-9992
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICHOLAS COLEMAN
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Credential | DC
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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 | 9798
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License Number State | TX
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