=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437963329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID-CITIES MEDICAL MANAGEMENT PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2025
-----------------------------------------------------
Last Update Date | 02/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 729 W BEDFORD EULESS RD STE 202
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76053-3941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-580-8200
-----------------------------------------------------
Fax | 817-406-2276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 729 W BEDFORD EULESS RD STE 202
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76053-3941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-580-8200
-----------------------------------------------------
Fax | 817-406-2276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JON W. SCHWEITZER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 817-580-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------