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NPI Code Detail

MEDICARE: DALLAS INJURY REHAB LLC

MEDICARE: DALLAS INJURY REHAB LLC
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
1111NR0400XRehabilitation Chiropractor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18U8530OTHERTXBCBS

General Provider Information

NPI Number : 1174727838
Entity Type Code : Organization
Provider Name (Legal Business Name) : DALLAS INJURY REHAB LLC
Provider Business Mailing Address
First Line : PO BOX 600084
Second Line :
City : DALLAS
State : TX
Zip : 75360-0084
Country : US
Telephone Number : 214-357-7875
Fax Number : 972-557-7001
Provider Business Practice Location Address
First Line : 8208 BEDFORD EULESS RD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-7214
Country : US
Telephone Number : 817-498-7400
Fax Number : 817-503-9967
Authorized Official
Title or Position : PROPRIETOR
Name : NICHOLAS MIRRO
Credential : D.C.
Telephone Number : 817-498-7400
Provider Enumeration Date : 06/14/2007
Last Update Date : 10/13/2009

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Directions to “DALLAS INJURY REHAB LLC ” Practice Location

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