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General NPI Number Information
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NPI Number | 1154552834
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Entity Type | Organization
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Legal Business Name | PRO-ADJUSTER CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 07/29/2009
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 103 E BELT LINE RD STE. G
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City | CEDAR HILL
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State | TX
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Zip | 75104-2274
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Country | US
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Telephone | 972-291-1992
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Fax | 972-291-1163
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Provider Business Mailing Address
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Address Line | 103 E BELT LINE RD STE. G
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City | CEDAR HILL
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State | TX
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Zip | 75104-2274
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Country | US
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Telephone | 972-291-1992
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Fax | 972-291-1163
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. LESA GILLEZEAU ANSELL
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Credential | D.C., R.N.
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Telephone | 972-291-1992
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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 | 8020
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License Number State | TX
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