=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689816811
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIK JOSHUA GRAGG D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2009
-----------------------------------------------------
Last Update Date | 04/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13021 COIT RD 106
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-5789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-503-6325
-----------------------------------------------------
Fax | 972-503-1954
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5700 HENRY COOK BLVD APT 6325
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75024-4542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-212-1730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 11148
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 11148
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------