=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386860336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST CHOICE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11722 MARSH LN SUITE 326
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75229-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-358-3331
-----------------------------------------------------
Fax | 214-358-3513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 631813
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75063-0029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-358-3331
-----------------------------------------------------
Fax | 214-358-3513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | DR. ROBIN CHARLES STANLEY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 214-358-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 9879
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------