1376654046 NPI number — PRIME GLOBAL ENTERPRISES, INC

Table of content: (NPI 1376654046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376654046 NPI number — PRIME GLOBAL ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME GLOBAL ENTERPRISES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHIROPRACTIC DOCTORS CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376654046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 701359
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75370-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-674-2812
Provider Business Mailing Address Fax Number:
972-818-9779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3307 BELT LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75044-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-496-2225
Provider Business Practice Location Address Fax Number:
972-496-3531
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHIRVANI
Authorized Official First Name:
SHIVA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNERCHIROPRACTOR
Authorized Official Telephone Number:
214-674-2812

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 6778 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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