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General NPI Number Information
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NPI Number | 1598969248
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Entity Type | Organization
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Legal Business Name | DALLAS INJURY REHAB LLC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 320 REGAL ROW SUITE 100
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City | DALLAS
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State | TX
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Zip | 75247-5200
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Country | US
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Telephone | 214-357-7875
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Fax | 972-557-7001
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Provider Business Mailing Address
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Address Line | PO BOX 600084
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City | DALLAS
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State | TX
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Zip | 75360-0084
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Country | US
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Telephone | 214-357-7875
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Fax | 972-557-7001
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Authorized Official
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Title or Position | PROPRIETOR
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Name | NICHOLAS MIRRO
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Credential | D.C.
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Telephone | 214-357-7875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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