MEDICARE: ROCKWALL INVESTORS LIMITED, 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1194040428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKWALL INVESTORS LIMITED, LLC

Provider Business Mailing Address
First Line	:	3712 W 7TH ST STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 W 7TH ST STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2536
Country	:	US
Telephone Number	:	972-897-3280
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN HICKEY
Credential	:	D.C.
Telephone Number	:	972-897-3280

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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Directions to “ROCKWALL INVESTORS LIMITED, LLC ” Practice Location

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