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General NPI Number Information
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NPI Number | 1700437845
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Entity Type | Organization
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Legal Business Name | DIAMONDBACK MEDICAL LLC
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 3721 S STONEBRIDGE DR UNIT 1202
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City | MCKINNEY
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State | TX
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Zip | 75070-0236
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Country | US
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Telephone | 214-842-8500
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Fax | 972-767-3158
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Provider Business Mailing Address
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Address Line | 3721 S STONEBRIDGE DR UNIT 1202
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City | MCKINNEY
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State | TX
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Zip | 75070-0236
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Country | US
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Telephone | 214-842-8500
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Fax | 972-767-3158
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | JOSEPH P KLOTZ
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Credential | DC
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Telephone | 214-842-8500
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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 |
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License Number State |
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