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General NPI Number Information
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NPI Number | 1336514280
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Entity Type | Organization
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Legal Business Name | CAMP WISDOM BACK & NECK CARE CENTER
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 217 E CAMP WISDOM RD STE D NONE
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City | DUNCANVILLE
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State | TX
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Zip | 75116-2769
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Country | US
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Telephone | 972-296-6173
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Fax | 972-296-6192
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Provider Business Mailing Address
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Address Line | 217 E CAMP WISDOM RD STE D NONE
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City | DUNCANVILLE
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State | TX
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Zip | 75116-2769
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Country | US
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Telephone | 972-296-6173
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Fax | 972-296-6192
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | MICHAEL WILLIAM HOWE
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Credential | D.C.
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Telephone | 972-296-6173
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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 | 3030
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License Number State | TX
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