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General NPI Number Information
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NPI Number | 1922735141
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Entity Type | Organization
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Legal Business Name | 100 CHIRO PRINCE PLLC
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Dates
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Enumeration Date | 08/07/2022
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Last Update Date | 08/07/2022
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Provider Practice Location Address
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Address Line | 2757 E SOUTHLAKE BLVD STE A110
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8014
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Country | US
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Telephone | 214-498-6263
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Fax |
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Provider Business Mailing Address
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Address Line | 8809 COPPER RIVER DR
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City | FORT WORTH
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State | TX
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Zip | 76131-2565
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Country | US
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Telephone | 214-498-6263
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | COURTNEY DIANE PRINCE
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Credential | DC
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Telephone | 214-498-6263
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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 |
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License Number State |
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