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General NPI Number Information
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NPI Number | 1831639947
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Entity Type | Organization
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Legal Business Name | MAVERICK CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 205 S BOIS D ARC ST
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City | FORNEY
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State | TX
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Zip | 75126
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Country | US
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Telephone | 972-564-9994
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3073
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City | FORNEY
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State | TX
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Zip | 75126-3073
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JOSHUA FARMER
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Credential | DC
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Telephone | 682-320-7485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 13349
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License Number State | TX
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