=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902979685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE PAIN CENTERS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 06/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 N DALLAS PKWY SUITE 150
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-0383
-----------------------------------------------------
Fax | 972-403-3434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 N DALLAS PKWY SUITE 150
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-378-0383
-----------------------------------------------------
Fax | 972-492-2074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JADE MALAY
-----------------------------------------------------
Credential | DC, DABCO
-----------------------------------------------------
Telephone | 972-378-0383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NX0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Chiropractor
-----------------------------------------------------
License Number | DC6310
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------