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General NPI Number Information
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NPI Number | 1174788590
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Entity Type | Organization
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Legal Business Name | LITTLE ELM ORTHOPEDIC AND SPINE REHAB PC
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 3033 BELLA VISTA LN
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City | LITTLE ELM
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State | TX
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Zip | 75068-7839
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Country | US
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Telephone | 214-492-9112
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Fax | 469-362-4731
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Provider Business Mailing Address
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Address Line | 3033 BELLA VISTA LN
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City | LITTLE ELM
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State | TX
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Zip | 75068-7839
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Country | US
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Telephone | 214-492-9112
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Fax | 469-362-4731
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Authorized Official
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Title or Position | CEO
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Name | DR. DANIEL MARK RICHARD
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Credential | DC
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Telephone | 214-492-9112
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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 | 10256
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1150609
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License Number State | TX
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