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General NPI Number Information
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NPI Number | 1316422058
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Entity Type | Organization
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Legal Business Name | REHAB RECOVERY PERFORM CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 6601 WATAUGA RD STE 100
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City | WATAUGA
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State | TX
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Zip | 76148-3369
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Country | US
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Telephone | 817-629-4348
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Fax |
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Provider Business Mailing Address
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Address Line | 8098 N FM ROAD 51
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City | SPRINGTOWN
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State | TX
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Zip | 76082-6600
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Country | US
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Telephone | 951-834-8504
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/OWNER
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Name | DR. DEREK NELSON
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Credential | DC
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Telephone | 951-834-8504
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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 |
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License Number State |
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