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General NPI Number Information
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NPI Number | 1750751087
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Entity Type | Organization
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Legal Business Name | REHAB PERFORMANCE MASTERS CHIROPRACTIC SPORTS & WELLNESS, LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 1834 KELLER PKWY STE 300
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City | KELLER
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State | TX
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Zip | 76248-3761
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Country | US
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Telephone | 469-515-9051
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Fax | 817-288-0605
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Provider Business Mailing Address
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Address Line | 1834 KELLER PKWY STE 300
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City | KELLER
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State | TX
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Zip | 76248-3761
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Country | US
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Telephone | 469-515-9051
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Fax | 817-288-0605
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CARLEY LYNN PEARCE
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Credential | D.C.
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Telephone | 469-515-9051
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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 |
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License Number State |
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