Provider Demographics
NPI:1376685511
Name:EXPRESSIONS CHIROPRACTIC & REHAB CENTER, PA
Entity Type:Organization
Organization Name:EXPRESSIONS CHIROPRACTIC & REHAB CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRTLAND
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SPEAKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-291-4455
Mailing Address - Street 1:510 W FM 1382
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5322
Mailing Address - Country:US
Mailing Address - Phone:972-291-4455
Mailing Address - Fax:972-291-5976
Practice Address - Street 1:510 W FM 1382
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5322
Practice Address - Country:US
Practice Address - Phone:972-291-4455
Practice Address - Fax:972-291-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612352Medicare ID - Type Unspecified
TXU53866Medicare UPIN