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General NPI Number Information
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NPI Number | 1659932291
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Entity Type | Organization
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Legal Business Name | DESTIN LEGACY INC
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 2200 LOS RIOS BLVD STE 127
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City | PLANO
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State | TX
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Zip | 75074-3478
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Country | US
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Telephone | 972-424-4266
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Fax | 972-424-4266
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Provider Business Mailing Address
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Address Line | 4101 E PARK BLVD STE 121
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City | PLANO
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State | TX
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Zip | 75074-3409
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Country | US
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Telephone | 972-424-4266
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Fax | 972-424-4266
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRYSTAL LINSTEADT
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Credential | LMT
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Telephone | 972-424-4266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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