MEDICARE: CLIFFORD CHIRO, PLLC

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	111NN0400X	Neurology Chiropractor

General Provider Information

NPI Number	:	1093192098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD CHIRO, PLLC

Provider Business Mailing Address
First Line	:	4222 TRINITY MILLS RD STE 106
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-7604
Country	:	US
Telephone Number	:	972-934-1660
Fax Number	:	972-934-1633

Provider Business Practice Location Address
First Line	:	4222 TRINITY MILLS RD STE 106
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-7604
Country	:	US
Telephone Number	:	972-934-1660
Fax Number	:	972-934-1633

Authorized Official
Title or Position	:	OWNER
Name	:	ROGER CLIFFORD
Credential	:	DC, DACNB
Telephone Number	:	972-934-1660

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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