1487757878 NPI number — DALLAS MULTIDISCIPLINARY CLINIC, P.A

Table of content: (NPI 1487757878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487757878 NPI number — DALLAS MULTIDISCIPLINARY CLINIC, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS MULTIDISCIPLINARY CLINIC, P.A
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:
1487757878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9669 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-5053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-265-9000
Provider Business Mailing Address Fax Number:
214-696-1757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9669 N CENTRAL EXPWY
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-265-9000
Provider Business Practice Location Address Fax Number:
214-696-1757
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEDDLE
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
214-265-9000

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  N6319 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 6798 , 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)





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