=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598474512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BACKWORX CHIROPRACTIC AND DECOMPRESSION, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2022
-----------------------------------------------------
Last Update Date | 11/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5310 N TARRANT PKWY STE 132
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76244-7300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-849-2165
-----------------------------------------------------
Fax | 817-849-2208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5310 N TARRANT PKWY STE 132
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76244-7300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-849-2165
-----------------------------------------------------
Fax | 817-849-2208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DR. JEFFREY ALAN ZWIERSTRA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 817-343-1143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------