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General NPI Number Information
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NPI Number | 1750976601
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Entity Type | Organization
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Legal Business Name | RESTORE LIFE CHIROPRACTIC
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 1090 SCHOOLHOUSE RD STE 500
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City | HASLET
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State | TX
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Zip | 76052-3776
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Country | US
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Telephone | 817-251-1637
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Fax | 817-391-1530
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Provider Business Mailing Address
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Address Line | 1090 SCHOOLHOUSE RD STE 500
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City | HASLET
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State | TX
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Zip | 76052-3776
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Country | US
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Telephone | 817-251-1637
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Fax | 817-391-1530
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. JOE DANIEL KENNEDY
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Credential | DC
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Telephone | 817-251-1637
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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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