1013017987 NPI number — NORTH DALLAS ADVANCED DIAGNOSTIC PA

Table of content: (NPI 1013017987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013017987 NPI number — NORTH DALLAS ADVANCED DIAGNOSTIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH DALLAS ADVANCED DIAGNOSTIC PA
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:
Provider Other Organization Name Type Code:
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:
1013017987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 703324
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:
75370-3324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-276-3320
Provider Business Mailing Address Fax Number:
580-276-3321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 OHIO DR
Provider Second Line Business Practice Location Address:
SUITE 200 A
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-620-5987
Provider Business Practice Location Address Fax Number:
866-818-2129
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASSADOLLAHI
Authorized Official First Name:
REZA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
866-620-5987

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  07107 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07107 . This is a "TEXAS BOARD OF CHIROPRACTIC EXAMINERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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