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General NPI Number Information
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NPI Number | 1568609410
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Entity Type | Organization
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Legal Business Name | MONROE CHIROPRACTIC & SPORTS THERAPY, P.A.
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 2200 POOL RD SUITE 108
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City | GRAPEVINE
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State | TX
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Zip | 76051-4266
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Country | US
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Telephone | 817-421-1300
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Fax | 817-488-6723
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Provider Business Mailing Address
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Address Line | 2200 POOL RD SUITE 108
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City | GRAPEVINE
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State | TX
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Zip | 76051-4266
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Country | US
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Telephone | 817-421-1300
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Fax | 817-488-6723
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Authorized Official
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Title or Position | PRESIDENT
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Name | KYRA MONROE
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Credential | DC
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Telephone | 817-421-1300
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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 | 10917
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License Number State | TX
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