MEDICARE: EXPLORATORY & DIAGNOSTIC IMAGING CENTER

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	111NR0200X	Radiology Chiropractor	G6311	TX
2	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	G6311	TX
3	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	G6311	TX

General Provider Information

NPI Number	:	1205979705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPLORATORY & DIAGNOSTIC IMAGING CENTER

Provider Business Mailing Address
First Line	:	2301 S HAMPTON RD
Second Line	:	SUITE 700
City	:	DALLAS
State	:	TX
Zip	:	75224-1650
Country	:	US
Telephone Number	:	214-333-4200
Fax Number	:	214-333-9911

Provider Business Practice Location Address
First Line	:	2301 S HAMPTON RD
Second Line	:	SUITE 700
City	:	DALLAS
State	:	TX
Zip	:	75224-1650
Country	:	US
Telephone Number	:	214-333-4200
Fax Number	:	214-333-9911

Authorized Official
Title or Position	:	ORTHOPAEDIC SURGEON
Name	:	DR. LARRY T JOHNSON
Credential	:	MD
Telephone Number	:	214-333-4200

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	09/11/2025

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Directions to “EXPLORATORY & DIAGNOSTIC IMAGING CENTER ” Practice Location

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