1649604380 NPI number — CARMACK CHIROPRACTIC AND SPORTS THERAPY

Table of content: (NPI 1649604380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649604380 NPI number — CARMACK CHIROPRACTIC AND SPORTS THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARMACK CHIROPRACTIC AND SPORTS THERAPY
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:
1649604380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 RIVER WALK DR
Provider Second Line Business Mailing Address:
SUITE 165
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-899-9818
Provider Business Mailing Address Fax Number:
972-899-9819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 RIVER WALK DR
Provider Second Line Business Practice Location Address:
SUITE 165
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-899-9818
Provider Business Practice Location Address Fax Number:
972-899-9819
Provider Enumeration Date:
08/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CARMACK
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
469-262-9681

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  10941 , 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)





Copyright © 2007-2025 www.npivalidator.com