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General NPI Number Information
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NPI Number | 1710255674
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Entity Type | Organization
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Legal Business Name | LIBERTY HEALTH
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 4373 S HAMPTON RD
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City | DALLAS
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State | TX
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Zip | 75232-1058
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Country | US
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Telephone | 214-339-2460
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Fax | 214-339-2387
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Provider Business Mailing Address
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Address Line | PO BOX 1305
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City | COPPELL
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State | TX
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Zip | 75019-1305
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Country | US
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Telephone | 817-907-1009
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. DANIEL LEE PENNELL
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Credential | D.C.
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Telephone | 214-339-2460
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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 | 11401
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License Number State | TX
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