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General NPI Number Information
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NPI Number | 1568119352
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Entity Type | Individual
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Provider Name | FISSEHA GEBREGZIABHER GEBREMEDHIN DC
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Gender | Male
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Dates
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Enumeration Date | 03/02/2022
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 5335 W SUBLETT RD
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City | ARLINGTON
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State | TX
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Zip | 76017-1184
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Country | US
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Telephone | 817-890-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 10110 WALNUT ST APT 109
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City | DALLAS
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State | TX
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Zip | 75243-5156
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Country | US
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Telephone | 214-780-9777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 14490
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License Number State | TX
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