MEDICARE: CHIROPRACTIC HEALTH CENTER OF GRAND PRAIRIE, 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	111N00000X	Chiropractor	7931	TX

General Provider Information

NPI Number	:	1205865003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC HEALTH CENTER OF GRAND PRAIRIE, LLC

Provider Business Mailing Address
First Line	:	5425 W SPRING CREEK PKWY
Second Line	:	SUITE 270
City	:	PLANO
State	:	TX
Zip	:	75024-4236
Country	:	US
Telephone Number	:	972-647-4175
Fax Number	:	817-287-0001

Provider Business Practice Location Address
First Line	:	5425 W SPRING CREEK PKWY
Second Line	:	SUITE 270
City	:	PLANO
State	:	TX
Zip	:	75024-4236
Country	:	US
Telephone Number	:	972-801-2190
Fax Number	:	817-287-0001

Authorized Official
Title or Position	:	OWNER CHIROPRACTOR
Name	:	DOUGLAS L BEMAN
Credential	:	D.C.
Telephone Number	:	972-647-4175

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	10/25/2012

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