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General NPI Number Information
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NPI Number | 1164055141
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Entity Type | Organization
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Legal Business Name | FORT WORTH CHIROPRACTIC CLINIC PLLC
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Dates
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Enumeration Date | 02/18/2020
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 2920 OAK PARK CIR STE 101
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City | FORT WORTH
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State | TX
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Zip | 76109-1853
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Country | US
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Telephone | 817-924-7243
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Fax | 817-924-0284
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Provider Business Mailing Address
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Address Line | 2920 OAK PARK CIR STE 101
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City | FORT WORTH
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State | TX
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Zip | 76109-1853
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Country | US
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Telephone | 817-924-7243
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Fax | 817-924-0284
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHEILA R PAGE
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Credential |
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Telephone | 817-797-6280
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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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