=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265442156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATED CHIROPRACTIC PROFESSIONALS, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6310 LYNDON B JOHNSON FWY STE 115
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-6424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-490-9888
-----------------------------------------------------
Fax | 972-490-9830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6310 LYNDON B JOHNSON FWY STE 115
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-6424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-490-8888
-----------------------------------------------------
Fax | 972-490-9830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JONATHAN E WOODWARD
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 972-490-9888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------