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General NPI Number Information
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NPI Number | 1629205596
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Entity Type | Organization
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Legal Business Name | BLCWC
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 5072 W PLANO PKWY SUITE 130
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City | PLANO
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State | TX
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Zip | 75093-4476
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Country | US
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Telephone | 214-649-2718
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Fax |
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Provider Business Mailing Address
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Address Line | 5072 W PLANO PKWY SUITE 130
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City | PLANO
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State | TX
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Zip | 75093-4476
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Country | US
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Telephone | 214-649-2718
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | JULIE PLENTL
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Credential |
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Telephone | 214-649-2718
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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 | 9521
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License Number State | TX
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