1821494113 NPI number — PINNACLE POINT CLINIC OF CHIROPRACTIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821494113 NPI number — PINNACLE POINT CLINIC OF CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE POINT CLINIC OF CHIROPRACTIC
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:
1821494113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2304 BARDIN RD
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75052-3850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-789-4225
Provider Business Mailing Address Fax Number:
817-840-6407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2304 BARDIN RD
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75052-3850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-789-4225
Provider Business Practice Location Address Fax Number:
817-840-6407
Provider Enumeration Date:
11/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BALDWIN
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-270-5163

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  12220 , 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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