MEDICARE: DALLAS MULTIDISCIPLINARY CLINIC, P.A

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	208100000X	Physical Medicine & Rehabilitation Physician	N6319	TX
2	111N00000X	Chiropractor	6798	TX

General Provider Information

NPI Number	:	1487757878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS MULTIDISCIPLINARY CLINIC, P.A

Provider Business Mailing Address
First Line	:	9669 N CENTRAL EXPY
Second Line	:	STE 200
City	:	DALLAS
State	:	TX
Zip	:	75231-5053
Country	:	US
Telephone Number	:	214-265-9000
Fax Number	:	214-696-1757

Provider Business Practice Location Address
First Line	:	9669 N CENTRAL EXPWY
Second Line	:	STE 200
City	:	DALLAS
State	:	TX
Zip	:	75231
Country	:	US
Telephone Number	:	214-265-9000
Fax Number	:	214-696-1757

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	BRYAN L WEDDLE
Credential	:	DC
Telephone Number	:	214-265-9000

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	06/26/2014

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Directions to “DALLAS MULTIDISCIPLINARY CLINIC, P.A ” Practice Location

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