=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982254447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE PACE CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2019
-----------------------------------------------------
Last Update Date | 10/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 WATER ST
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-3260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-923-2616
-----------------------------------------------------
Fax | 972-937-0605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 WATER ST
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75165-3260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-923-2616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR/ OWNER
-----------------------------------------------------
Name | DR. KRYSTLE MORELAND
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 972-923-0005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------