MEDICARE: HALTOM PAIN AND INJURY

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	:	1447515937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALTOM PAIN AND INJURY

Provider Business Mailing Address
First Line	:	3023 MESETA
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 HALTOM RD STE C
Second Line	:
City	:	HALTOM CITY
State	:	TX
Zip	:	76117-5037
Country	:	US
Telephone Number	:	972-859-0534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTI RODRIGUEZ
Credential	:
Telephone Number	:	972-859-0534

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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Directions to “HALTOM PAIN AND INJURY ” Practice Location

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