MEDICARE: DR. AMBER N NEVELS DC

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	13340	TX

General Provider Information

NPI Number	:	1326558644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER N NEVELS DC

Provider Business Mailing Address
First Line	:	5275 TOWN AND COUNTRY BLVD APT 2207
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-6245
Country	:	US
Telephone Number	:	512-619-4844
Fax Number	:

Provider Business Practice Location Address
First Line	:	12584 N BEACH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4249
Country	:	US
Telephone Number	:	817-431-2080
Fax Number	:

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	11/02/2018

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