MEDICARE: DFW QAT

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	:	1386854404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DFW QAT

Provider Business Mailing Address
First Line	:	1715 W BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3402
Country	:	US
Telephone Number	:	214-718-0529
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 W BERRY ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3402
Country	:	US
Telephone Number	:	214-718-0529
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. QUANG ANH TRAN
Credential	:
Telephone Number	:	214-718-0529

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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