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General NPI Number Information
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NPI Number | 1942791116
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Entity Type | Organization
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Legal Business Name | ILLUMIN8 MCKINNEY CHIROPRACTIC
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 105 S TENNESSEE ST STE 101
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City | MCKINNEY
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State | TX
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Zip | 75069-4354
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Country | US
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Telephone | 469-309-3410
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Fax |
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Provider Business Mailing Address
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Address Line | 833 SILVER AVE SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3020
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Country | US
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Telephone | 505-433-4646
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Fax |
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Authorized Official
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Title or Position | DC
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Name | SHELBY PAIGE PHELPS
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Credential |
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Telephone | 469-309-3410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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