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General NPI Number Information
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NPI Number | 1194962373
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Entity Type | Organization
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Legal Business Name | DR. ANDY CHIROPRACTIC
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 2334 W BUCKINGHAM RD STE 360
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City | GARLAND
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State | TX
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Zip | 75042-3940
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Country | US
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Telephone | 972-272-7788
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Fax | 972-272-0088
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Provider Business Mailing Address
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Address Line | 2334 W BUCKINGHAM RD STE 360
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City | GARLAND
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State | TX
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Zip | 75042-3940
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Country | US
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Telephone | 972-272-7788
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Fax | 972-272-0088
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. PHOUNSAVATH ANDY PHILACHACK
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Credential | D.C.
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Telephone | 972-272-7788
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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 | 8631
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License Number State | TX
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