Provider Demographics
NPI:1205220167
Name:DALLAS HEALTH 360, LLC
Entity Type:Organization
Organization Name:DALLAS HEALTH 360, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-954-4357
Mailing Address - Street 1:400 N SAINT PAUL ST
Mailing Address - Street 2:200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-3114
Mailing Address - Country:US
Mailing Address - Phone:214-954-4357
Mailing Address - Fax:469-920-9574
Practice Address - Street 1:400 N SAINT PAUL ST
Practice Address - Street 2:200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-3114
Practice Address - Country:US
Practice Address - Phone:214-954-4357
Practice Address - Fax:469-920-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
TX12040111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1205220167OtherGROUP NPI
TX123EC64398OtherDOCUMENT CONTROL NUMBER - VA
TX1205220167OtherGROUP NPI