Provider Demographics
NPI:1124586235
Name:JOSEY LANE CHIROPRACTIC AND REHAB CENTER
Entity Type:Organization
Organization Name:JOSEY LANE CHIROPRACTIC AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CIANCIULLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:972-492-5670
Mailing Address - Street 1:3730 N JOSEY LN STE 122
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2439
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:972-492-5679
Practice Address - Street 1:3730 N JOSEY LN STE 122
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2439
Practice Address - Country:US
Practice Address - Phone:972-492-5670
Practice Address - Fax:972-492-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty