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General NPI Number Information
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NPI Number | 1972741775
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Entity Type | Organization
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Legal Business Name | DACUS CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 02/02/2009
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 2771 E BROAD ST STE 211
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City | MANSFIELD
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State | TX
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Zip | 76063-9157
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Country | US
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Telephone | 682-518-6263
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Fax | 682-325-3733
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Provider Business Mailing Address
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Address Line | 2771 E BROAD ST STE 211
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City | MANSFIELD
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State | TX
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Zip | 76063-9157
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Country | US
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Telephone | 682-518-6263
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Fax | 682-325-3733
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CLINTON KEITH DACUS
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Credential | D.C.
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Telephone | 682-518-6263
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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 | 11063
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License Number State | TX
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