MEDICARE: DAVID BACK CLINIC OF AMERICA

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	2081P0004X	Spinal Cord Injury Medicine Physician
2	207L00000X	Anesthesiology Physician	E6117	TX

General Provider Information

NPI Number	:	1497953988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID BACK CLINIC OF AMERICA

Provider Business Mailing Address
First Line	:	3800 HULEN ST
Second Line	:	#110
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7276
Country	:	US
Telephone Number	:	817-921-9983
Fax Number	:	817-763-9985

Provider Business Practice Location Address
First Line	:	3800 HULEN ST
Second Line	:	#110
City	:	FORT WORTH
State	:	TX
Zip	:	76107-7276
Country	:	US
Telephone Number	:	817-921-9983
Fax Number	:	817-763-9985

Authorized Official
Title or Position	:	PARTNER -VP NATIONAL DEVELOPMENT
Name	:	BOB SCHLINKMAN
Credential	:	D.C.
Telephone Number	:	972-839-3250

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	07/12/2007

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Directions to “DAVID BACK CLINIC OF AMERICA ” Practice Location

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