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General NPI Number Information
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NPI Number | 1932292612
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Entity Type | Individual
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Provider Name | TINA MICHELLE INGRAM DC, FNP-C, DIPL.AC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 921 W DALLAS ST
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City | CANTON
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State | TX
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Zip | 75103-1009
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Country | US
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Telephone | 903-567-5579
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Fax | 903-567-5938
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Provider Business Mailing Address
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Address Line | 921 W DALLAS ST
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City | CANTON
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State | TX
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Zip | 75103-1009
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Country | US
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Telephone | 903-567-5579
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Fax | 903-567-5938
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6598
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1012507
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License Number State | TX
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