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General NPI Number Information
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NPI Number | 1750692125
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Entity Type | Organization
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Legal Business Name | NECK & BACK CENTER
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 4100 W 15TH ST STE 206
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City | PLANO
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State | TX
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Zip | 75093-5801
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Country | US
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Telephone | 972-985-9048
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Fax | 972-596-7570
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Provider Business Mailing Address
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Address Line | 4100 W 15TH ST STE 206
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City | PLANO
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State | TX
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Zip | 75093-5801
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Country | US
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Telephone | 972-985-9048
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Fax | 972-596-7570
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Authorized Official
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Title or Position | OWNER
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Name | MIKE O'KELLEY
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Credential | D.C.
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Telephone | 972-985-9048
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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 | 2650
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License Number State | TX
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