=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326156597
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOMATIC CHIROPRACTIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7517 CAMPBELL RD STE 606
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-930-9566
-----------------------------------------------------
Fax | 972-930-9710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4607 REFUGIO RD
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-8495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-930-9566
-----------------------------------------------------
Fax | 972-930-9710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MITCHELL SHUCHMAN ADAM SHUCHMAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 972-930-9566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8863
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------