Provider Demographics
NPI:1548427859
Name:CHIROPRACTIC & ACUPUNCTURE PAIN MANAGEMENT CLINIC, PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC & ACUPUNCTURE PAIN MANAGEMENT CLINIC, PLLC
Other - Org Name:TEXAS CHIROPRACTIC & ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:TIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-238-0500
Mailing Address - Street 1:9751 WALNUT ST STE 108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2345
Mailing Address - Country:US
Mailing Address - Phone:972-238-0500
Mailing Address - Fax:
Practice Address - Street 1:9751 WALNUT ST STE 108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2345
Practice Address - Country:US
Practice Address - Phone:972-238-0500
Practice Address - Fax:972-238-0045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty