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General NPI Number Information
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NPI Number | 1871361881
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Entity Type | Organization
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Legal Business Name | FLOW STATE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 4611 PRESTON RD STE 150
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City | FRISCO
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State | TX
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Zip | 75034-7601
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Country | US
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Telephone | 469-200-5046
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Fax |
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Provider Business Mailing Address
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Address Line | 11929 VIENNA APPLE RD
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City | FORT WORTH
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State | TX
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Zip | 76244-7582
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Country | US
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Telephone | 516-581-2224
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTIC/OWNER
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Name | POTSAWAT KHAMHAENG
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Credential | DC
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Telephone | 516-581-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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