MEDICARE: PARK HILL CHIROPRACTIC AND REHABILITATION 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	12905	TX

General Provider Information

NPI Number	:	1689040388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK HILL CHIROPRACTIC AND REHABILITATION PLLC

Provider Business Mailing Address
First Line	:	2428 FOREST PARK BLVD
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1780
Country	:	US
Telephone Number	:	682-703-1529
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 FOREST PARK BLVD
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76110-1780
Country	:	US
Telephone Number	:	682-703-1529
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SETH ELLIOTT
Credential	:	DC
Telephone Number	:	405-664-8671

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

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