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General NPI Number Information
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NPI Number | 1972625556
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Entity Type | Organization
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Legal Business Name | CARROLLTON ENTERPRISES CO.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | 1005 S JOSEY LN SUITE 203
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City | CARROLLTON
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State | TX
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Zip | 75006-7663
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Country | US
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Telephone | 972-417-0651
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Fax | 972-294-3789
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Provider Business Mailing Address
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Address Line | 4287 BELT LINE RD 303
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City | ADDISON
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State | TX
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Zip | 75001-4510
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Country | US
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Telephone | 972-417-0651
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Fax | 972-417-1851
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOM VAN PHAM
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Credential | D.C.
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Telephone | 972-417-0651
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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 | 7878
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License Number State | TX
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