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General NPI Number Information
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NPI Number | 1710114673
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Entity Type | Organization
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Legal Business Name | PERALTA CHIROPRACTIC INC
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 2727 S HAMPTON RD SUITE B
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City | DALLAS
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State | TX
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Zip | 75224-2327
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Country | US
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Telephone | 214-339-9900
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Fax | 214-339-9902
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Provider Business Mailing Address
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Address Line | 2727 S HAMPTON RD SUITE B
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City | DALLAS
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State | TX
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Zip | 75224-2327
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Country | US
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Telephone | 214-339-9900
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Fax | 214-339-9902
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. EDGAR JAMES PERALTA
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Credential | D.C
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Telephone | 214-339-9900
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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 | 10173
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License Number State | TX
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