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General NPI Number Information
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NPI Number | 1659681815
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Entity Type | Organization
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Legal Business Name | WORK ACCIDENT CHIROPRACTIC CLINIC, PLLC
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Dates
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Enumeration Date | 10/20/2010
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 9041 GARLAND RD
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City | DALLAS
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State | TX
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Zip | 75218-3919
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Country | US
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Telephone | 214-922-8844
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Fax | 214-368-5656
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Provider Business Mailing Address
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Address Line | P.O. BOX 601636
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City | DALLAS
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State | TX
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Zip | 75360-1636
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Country | US
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Telephone | 214-922-8844
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Fax | 214-368-5656
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN BOTEFUHR
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Credential | D.C.
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Telephone | 214-922-8844
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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 | DC 8668
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License Number State | TX
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