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NPI Code Detail

MEDICARE: FORT WORTH CHIROPRACTIC CLINIC PLLC

MEDICARE: FORT WORTH CHIROPRACTIC CLINIC 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
1111N00000XChiropractor

General Provider Information

NPI Number : 1164055141
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT WORTH CHIROPRACTIC CLINIC PLLC
Provider Business Mailing Address
First Line : 2920 OAK PARK CIR STE 101
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-1853
Country : US
Telephone Number : 817-924-7243
Fax Number : 817-924-0284
Provider Business Practice Location Address
First Line : 2920 OAK PARK CIR STE 101
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-1853
Country : US
Telephone Number : 817-924-7243
Fax Number : 817-924-0284
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. SHEILA R PAGE
Credential :
Telephone Number : 817-797-6280
Provider Enumeration Date : 02/18/2020
Last Update Date : 04/09/2020

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Directions to “FORT WORTH CHIROPRACTIC CLINIC PLLC ” Practice Location

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