=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275615247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC HEALTHCARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8680 MAIN STREET SUITE 3E
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-335-2004
-----------------------------------------------------
Fax | 972-335-2037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8680 MAIN STREET SUITE 3E
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-335-2004
-----------------------------------------------------
Fax | 972-335-2037
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING AGENT
-----------------------------------------------------
Name | MRS. MICHELLE LYNN TURNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-294-1346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC8849
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------