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General NPI Number Information
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NPI Number | 1386019735
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Entity Type | Organization
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Legal Business Name | PAIN RELIEF REHAB LLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 363 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3867
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Country | US
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Telephone | 972-436-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 363 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3867
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Country | US
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Telephone | 972-436-4434
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ROBERT DASILVA
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Credential | DC
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Telephone | 972-436-4434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 7121
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7121
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License Number State | TX
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