MEDICARE: NICHOLAS MIRRO D.C.

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	8371	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8U8530	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1184733800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MIRRO D.C.

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	:	214-350-1597

Provider Business Practice Location Address
First Line	:	320 REGAL ROW
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75247-5200
Country	:	US
Telephone Number	:	214-357-7875
Fax Number	:	972-557-7001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/13/2009

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Directions to “ NICHOLAS MIRRO D.C.” Practice Location

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