Provider Demographics
NPI:1568609410
Name:MONROE CHIROPRACTIC & SPORTS THERAPY, P.A.
Entity Type:Organization
Organization Name:MONROE CHIROPRACTIC & SPORTS THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-421-1300
Mailing Address - Street 1:2200 POOL RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4266
Mailing Address - Country:US
Mailing Address - Phone:817-421-1300
Mailing Address - Fax:817-488-6723
Practice Address - Street 1:2200 POOL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4266
Practice Address - Country:US
Practice Address - Phone:817-421-1300
Practice Address - Fax:817-488-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10917111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty