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General NPI Number Information
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NPI Number | 1194126417
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Entity Type | Organization
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Legal Business Name | 380 CHIROPRACTIC & WELLNESS LLC
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 2414 W UNIVERSITY DR 112
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City | MCKINNEY
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State | TX
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Zip | 75071-2853
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Country | US
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Telephone | 214-901-7211
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Fax | 214-975-2666
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Provider Business Mailing Address
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Address Line | 2414 W UNIVERSITY DR 112
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City | MCKINNEY
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State | TX
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Zip | 75071-2853
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Country | US
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Telephone | 214-901-7211
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Fax | 214-975-2666
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JOSEPH CACOZZA III
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Credential | D.C.
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Telephone | 214-901-7211
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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 | 10810
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License Number State | TX
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