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General NPI Number Information
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NPI Number | 1700201647
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Entity Type | Organization
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Legal Business Name | INNERGY FITNESS
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Dates
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Enumeration Date | 03/01/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 200 CRESCENT CT STE 95
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City | DALLAS
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State | TX
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Zip | 75201-7864
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Country | US
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Telephone | 918-408-4521
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CRESCENT CT STE 95
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City | DALLAS
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State | TX
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Zip | 75201-7864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. STEPHANIE HANSON
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Credential |
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Telephone | 214-801-5104
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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 | 12490
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License Number State | TX
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