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General NPI Number Information
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NPI Number | 1639496920
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PAIN SOLUTIONS
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 10935 ESTATE LN SUITE 444
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City | DALLAS
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State | TX
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Zip | 75238-2316
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Country | US
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Telephone | 214-221-0685
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Fax | 972-692-5772
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Provider Business Mailing Address
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Address Line | 10935 ESTATE LN SUITE 444
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City | DALLAS
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State | TX
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Zip | 75238-2316
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Country | US
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Telephone | 214-221-0685
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Fax | 972-692-5772
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. STEPHEN M TAYLOR
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Credential | DC
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Telephone | 214-221-0685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 2-2630
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number | 6788
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | E8702
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License Number State | TX
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