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General NPI Number Information
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NPI Number | 1437483831
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Entity Type | Organization
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Legal Business Name | SALANCE CLINIC, INC.
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 05/30/2017
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Provider Practice Location Address
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Address Line | 4255 BRYANT IRVIN RD STE 108
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City | FORT WORTH
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State | TX
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Zip | 76109-4224
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Country | US
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Telephone | 817-731-4848
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Fax | 817-731-4858
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Provider Business Mailing Address
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Address Line | 4255 BRYANT IRVIN RD STE 108
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City | FORT WORTH
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State | TX
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Zip | 76109-4224
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Country | US
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Telephone | 817-731-4848
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Fax | 817-731-4858
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Authorized Official
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Title or Position | OWNER/OFFICE PRESIDENT
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Name | ATHENA MARIE PAYNE
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Credential | D.C.
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Telephone | 817-731-4848
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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 | 10934
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License Number State | TX
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