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General NPI Number Information
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NPI Number | 1821315375
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Entity Type | Organization
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Legal Business Name | INJURY CLINIC OF DALLAS
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 935 CUSTER RD
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City | RICHARDSON
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State | TX
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Zip | 75080-5141
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Country | US
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Telephone | 972-466-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 935 CUSTER RD
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City | RICHARDSON
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State | TX
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Zip | 75080-5141
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Country | US
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Telephone | 972-466-5555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIDA F MEYMAND
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Credential | DC
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Telephone | 972-466-5555
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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 | 9629
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License Number State | TX
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