Provider Demographics
NPI:1437574027
Name:67 PAIN AND INJURY
Entity Type:Organization
Organization Name:67 PAIN AND INJURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-859-0524
Mailing Address - Street 1:700 S COCKRELL HILL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2600
Mailing Address - Country:US
Mailing Address - Phone:972-298-5222
Mailing Address - Fax:972-298-5223
Practice Address - Street 1:700 S COCKRELL HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2600
Practice Address - Country:US
Practice Address - Phone:972-298-5222
Practice Address - Fax:972-298-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty