Provider Demographics
NPI:1578609525
Name:DFW FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:DFW FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:DIVINA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-295-6404
Mailing Address - Street 1:PO BOX 225275
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-5275
Mailing Address - Country:US
Mailing Address - Phone:214-295-6404
Mailing Address - Fax:214-295-5428
Practice Address - Street 1:1610 FORT WORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-1507
Practice Address - Country:US
Practice Address - Phone:214-295-6404
Practice Address - Fax:214-295-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty