MEDICARE: DR. NADER JAMAL AWWAD D.C.

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	7108	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	606225	OTHER		BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1699705913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NADER JAMAL AWWAD D.C.

Provider Business Mailing Address
First Line	:	PO BOX 151482
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-7482
Country	:	US
Telephone Number	:	817-275-9249
Fax Number	:	817-275-9273

Provider Business Practice Location Address
First Line	:	3810 S COOPER ST
Second Line	:	SUITE 122
City	:	ARLINGTON
State	:	TX
Zip	:	76015-4149
Country	:	US
Telephone Number	:	817-275-9249
Fax Number	:	817-275-9273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	09/17/2012

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