Basic Information
Provider Information | |||||||||
NPI: | 1922240001 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FAMILY CHIROPRACTIC OF DALLAS, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SPINEWORKS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 937 MAIN ST | ||||||||
Address2: |   | ||||||||
City: | NEW MILFORD | ||||||||
State: | PA | ||||||||
PostalCode: | 188347431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5704653444 | ||||||||
FaxNumber: | 5704655400 | ||||||||
Practice Location | |||||||||
Address1: | 937 MAIN ST | ||||||||
Address2: |   | ||||||||
City: | NEW MILFORD | ||||||||
State: | PA | ||||||||
PostalCode: | 188347431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5704653444 | ||||||||
FaxNumber: | 5704655400 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/03/2009 | ||||||||
LastUpdateDate: | 03/07/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ALBERT | ||||||||
AuthorizedOfficialFirstName: | WILLIAM | ||||||||
AuthorizedOfficialMiddleName: | G | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5704653444 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: | III | ||||||||
AuthorizedOfficialCredential: | D.C. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC009867 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |   |
No ID Information.