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General NPI Number Information
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NPI Number | 1427168970
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Entity Type | Organization
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Legal Business Name | CHIROSPORT SPECIALISTS OF DALLAS
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 4950 BELT LINE RD STE 100
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City | DALLAS
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State | TX
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Zip | 75254-6751
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Country | US
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Telephone | 972-239-0010
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Fax |
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Provider Business Mailing Address
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Address Line | 4950 BELT LINE RD STE 100
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City | DALLAS
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State | TX
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Zip | 75254-6751
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Country | US
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Telephone | 972-239-0010
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | TROY CURTIS VAN BIEZEN
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Credential | D.C., A.R.T., B.P.E.
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Telephone | 972-239-0010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 7351
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License Number State | TX
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