Provider Demographics
NPI:1013014901
Name:DALLAS PHYSICAL PERFORMANCE CENTER
Entity Type:Organization
Organization Name:DALLAS PHYSICAL PERFORMANCE CENTER
Other - Org Name:DPPC
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASPRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-238-4112
Mailing Address - Street 1:1108 BALLY MOTE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3904
Mailing Address - Country:US
Mailing Address - Phone:214-220-1217
Mailing Address - Fax:214-220-1196
Practice Address - Street 1:601 N AKARD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3303
Practice Address - Country:US
Practice Address - Phone:214-220-1217
Practice Address - Fax:214-220-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2777111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0082NCOtherBCBS TEXAS GROUP