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General NPI Number Information
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NPI Number | 1720247844
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Entity Type | Organization
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Legal Business Name | DAVID BACK CLINIC OF AMERICA INC
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 3800 HULEN ST SUITE 110
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City | FORT WORTH
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State | TX
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Zip | 76107-7276
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Country | US
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Telephone | 817-921-9983
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Fax | 817-763-9985
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Provider Business Mailing Address
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Address Line | 3725 COCKRELL AVE
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City | FORT WORTH
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State | TX
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Zip | 76110-4602
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Country | US
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Telephone | 817-921-9981
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Fax | 817-921-1407
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | MS. CARMA ANDERSON
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Credential |
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Telephone | 817-921-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | TX
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