Provider Demographics
NPI:1073792461
Name:CHIROMED HEALTHCARE, PA
Entity Type:Organization
Organization Name:CHIROMED HEALTHCARE, PA
Other - Org Name:TRINITY INJURY & PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-515-9300
Mailing Address - Street 1:3821 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5245
Mailing Address - Country:US
Mailing Address - Phone:214-515-9300
Mailing Address - Fax:214-515-9302
Practice Address - Street 1:3821 ROSS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5245
Practice Address - Country:US
Practice Address - Phone:214-515-9300
Practice Address - Fax:214-515-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101204Medicare PIN
TXTXB101220Medicare PIN