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General NPI Number Information
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NPI Number | 1396883724
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Entity Type | Organization
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Legal Business Name | AGRITELLEY INC.
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 6060 DILBECK LN
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City | DALLAS
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State | TX
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Zip | 75240-5351
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Country | US
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Telephone | 469-916-1592
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Fax | 972-458-6829
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Provider Business Mailing Address
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Address Line | 6060 DILBECK LN
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City | DALLAS
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State | TX
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Zip | 75240-5351
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Country | US
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Telephone | 469-916-1592
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Fax | 972-458-6829
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CAMILLE CATHERINE EBERLE
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Credential | D.C.
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Telephone | 469-916-1592
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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 | 10258
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1153020
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 9065
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License Number State | TX
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