Provider Demographics
NPI:1598969248
Name:DALLAS INJURY REHAB LLC
Entity Type:Organization
Organization Name:DALLAS INJURY REHAB LLC
Other - Org Name:DIR DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-357-7875
Mailing Address - Street 1:PO BOX 600084
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75360-0084
Mailing Address - Country:US
Mailing Address - Phone:214-357-7875
Mailing Address - Fax:972-557-7001
Practice Address - Street 1:320 REGAL ROW
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5200
Practice Address - Country:US
Practice Address - Phone:214-357-7875
Practice Address - Fax:972-557-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U8530OtherBCBS