MEDICARE: CHIROPRACTIC & ACUPUNCTURE PAIN MANAGEMENT CLINIC, PLLC

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	9779	TX

General Provider Information

NPI Number	:	1548427859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC & ACUPUNCTURE PAIN MANAGEMENT CLINIC, PLLC

Provider Business Mailing Address
First Line	:	9751 WALNUT ST STE 108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2345
Country	:	US
Telephone Number	:	972-238-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	9751 WALNUT ST STE 108
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2345
Country	:	US
Telephone Number	:	972-238-0500
Fax Number	:	972-238-0045

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. PHUONG QUOC TIEU
Credential	:	D.C.
Telephone Number	:	972-238-0500

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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