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General NPI Number Information
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NPI Number | 1902158199
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Entity Type | Organization
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Legal Business Name | TEXAS SPINE AND JOINT REHABILITATION
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 1401 THORPE LN
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City | SAN MARCOS
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State | TX
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Zip | 78666-6541
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Country | US
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Telephone | 512-392-3900
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Fax | 512-392-9939
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Provider Business Mailing Address
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Address Line | 1401 THORPE LN
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City | SAN MARCOS
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State | TX
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Zip | 78666-6541
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Country | US
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Telephone | 512-392-3900
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Fax | 512-392-9939
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Authorized Official
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Title or Position | CEO
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Name | DR. DANIEL LEE PENNELL
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Credential | D.C.
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Telephone | 214-675-0500
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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 | 11401
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License Number State | TX
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