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General NPI Number Information
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NPI Number | 1730197286
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Entity Type | Organization
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Legal Business Name | DALLAS SPINE CARE PA
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 9080 HARRY HINES BLVD SUITE 210
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City | DALLAS
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State | TX
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Zip | 75235-1720
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Country | US
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Telephone | 214-688-0078
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 JOHN W CARPENTER FWY PMB #8
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City | DALLAS
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State | TX
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Zip | 75247-4827
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Country | US
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Telephone | 214-688-0078
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ROBERT J HENDERSON
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Credential | M.D.
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Telephone | 214-688-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C1011
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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