MEDICARE: FAMILY HEALTH & SPINAL REJUVENATION CLINIC 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

General Provider Information

NPI Number	:	1336601947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH & SPINAL REJUVENATION CLINIC LLC

Provider Business Mailing Address
First Line	:	PO BOX 2210
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-7021
Country	:	US
Telephone Number	:	855-326-3644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1233 E PLEASANT RUN RD STE B
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-4200
Country	:	US
Telephone Number	:	855-326-3644
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	SHEDRACK RAINES
Credential	:
Telephone Number	:	817-629-1027

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	04/02/2019

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