Provider Demographics
NPI:1073708160
Name:DALTAK
Entity Type:Organization
Organization Name:DALTAK
Other - Org Name:DESOTO WELLNESS & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAUGHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-223-5055
Mailing Address - Street 1:314 S HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5746
Mailing Address - Country:US
Mailing Address - Phone:972-223-5055
Mailing Address - Fax:972-223-5353
Practice Address - Street 1:314 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5746
Practice Address - Country:US
Practice Address - Phone:972-223-5055
Practice Address - Fax:972-223-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4574111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038 PMOtherBCBSTX GROUP NO.
TX8X9480OtherBCBSTX PROVIDER NO.
TX8X9480OtherBCBSTX PROVIDER NO.