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General NPI Number Information
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NPI Number | 1932438231
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Entity Type | Organization
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Legal Business Name | ENLIGHTEN CHIROPRACTIC & ACUPUNCTURE
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 2238 MICHIGAN AVE STE D
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City | ARLINGTON
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State | TX
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Zip | 76013-5945
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Country | US
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Telephone | 817-458-1025
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Fax | 888-848-3798
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Provider Business Mailing Address
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Address Line | 15501 ADLONG DR
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City | ROANOKE
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State | TX
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Zip | 76262-3315
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Country | US
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Telephone | 817-458-1025
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Fax | 888-848-3798
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. VANDARA MOUNARATH
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Credential | D.C.
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Telephone | 817-458-1025
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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 | 11215
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License Number State | TX
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