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General NPI Number Information
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NPI Number | 1801151311
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Entity Type | Organization
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Legal Business Name | SYLVAN PAIN AND INJURY
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 1881 SYLVAN AVE STE 270
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City | DALLAS
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State | TX
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Zip | 75208-2085
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Country | US
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Telephone | 214-748-7070
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Fax | 214-748-7072
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Provider Business Mailing Address
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Address Line | 3023 MESETA
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City | GRAND PRAIRIE
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State | TX
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Zip | 75054-6746
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Country | US
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Telephone | 972-859-0534
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Fax | 682-518-8070
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Authorized Official
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Title or Position | OWNER
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Name | MARIO RODRIGUEZ
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Credential | D.C
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Telephone | 972-859-0534
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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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