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General NPI Number Information
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NPI Number | 1740934355
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Entity Type | Individual
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Provider Name | JORDAN DANIEL RASCH
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Gender | Male
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 4302 W LOVERS LN
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City | DALLAS
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State | TX
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Zip | 75209-2804
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Country | US
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Telephone | 214-862-1469
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Fax |
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Provider Business Mailing Address
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Address Line | 14155 DALLAS PKWY APT 1353
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City | DALLAS
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State | TX
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Zip | 75254-4450
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Country | US
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Telephone | 618-530-3694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 15033
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License Number State | TX
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