MEDICARE: COWTOWN CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1063987956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COWTOWN CHIROPRACTIC

Provider Business Mailing Address
First Line	:	4528 W VICKERY BLVD STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6263
Country	:	US
Telephone Number	:	817-423-2600
Fax Number	:	817-423-2601

Provider Business Practice Location Address
First Line	:	4528 W VICKERY BLVD STE 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6263
Country	:	US
Telephone Number	:	817-423-2600
Fax Number	:	817-423-2601

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. STEPHANIE M JANIAK
Credential	:	DC
Telephone Number	:	817-423-2600

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	10/30/2019

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Directions to “COWTOWN CHIROPRACTIC ” Practice Location

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