MEDICARE: SPINAL SOLUTIONS CHIROPRACTIC

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	5038	TX

General Provider Information

NPI Number	:	1770968968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINAL SOLUTIONS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	2413 S COLLINS ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1245
Country	:	US
Telephone Number	:	817-617-8005
Fax Number	:	817-617-8004

Provider Business Practice Location Address
First Line	:	2413 S COLLINS ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1245
Country	:	US
Telephone Number	:	817-617-8005
Fax Number	:	817-617-8004

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TRACEY H TRAN
Credential	:
Telephone Number	:	817-617-8005

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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