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General NPI Number Information
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NPI Number | 1912228545
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Entity Type | Organization
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Legal Business Name | INJURY MEDICAL DOCTORS, PLLC
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 8215 WESTCHESTER DR SUITE 221
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City | DALLAS
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State | TX
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Zip | 75225-6103
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Country | US
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Telephone | 214-361-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 8215 WESTCHESTER DR SUITE 221
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City | DALLAS
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State | TX
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Zip | 75225-6103
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Country | US
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Telephone | 214-361-2772
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ZACHARY TALLON
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Credential |
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Telephone | 214-361-2772
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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 | 11320
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4873
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License Number State | TX
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