=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750788394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERRELL CHIROPRACTIC SPINE & INJURY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2014
-----------------------------------------------------
Last Update Date | 11/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 606 W MOORE AVE
-----------------------------------------------------
City | TERRELL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75160-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-563-7246
-----------------------------------------------------
Fax | 972-563-0087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2149
-----------------------------------------------------
City | TERRELL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75160-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-563-7246
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC DIRECTOR
-----------------------------------------------------
Name | DR. MARSHA MILLER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 972-563-7246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 5870
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------