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General NPI Number Information
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NPI Number | 1235233750
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Entity Type | Organization
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Legal Business Name | COLIN TKACHUK
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 6224 COLLEYVILLE BLVD SUITE B
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City | COLLEYVILLE
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State | TX
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Zip | 76034-6276
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Country | US
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Telephone | 817-481-9339
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Fax | 817-481-9669
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Provider Business Mailing Address
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Address Line | 6224 COLLEYVILLE BLVD SUITE B
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City | COLLEYVILLE
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State | TX
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Zip | 76034-6276
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Country | US
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Telephone | 817-481-9339
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Fax | 817-481-9669
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | COLIN TKACHUK
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Credential | DC
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Telephone | 817-481-9339
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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 | 9771
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License Number State | TX
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