Provider Demographics
NPI:1598982308
Name:CHIROPRACTIC AND REHAB ASSOCIATES OF DALLAS, PC
Entity Type:Organization
Organization Name:CHIROPRACTIC AND REHAB ASSOCIATES OF DALLAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-696-4346
Mailing Address - Street 1:165 S MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TRUCKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1418
Mailing Address - Country:US
Mailing Address - Phone:570-696-4346
Mailing Address - Fax:
Practice Address - Street 1:165 S MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TRUCKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18708-1418
Practice Address - Country:US
Practice Address - Phone:570-696-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009260111NR0400X
PADC007819L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA814279OtherFIRSTPRIORITY-DR.MILLER
PA1630101OtherBLUESHIELD-DR. MORRIS
PA818354OtherFIRSTPRIORITY-DR.MORRIS
PA037425OtherBLUESHIELD-DR.MILLER
PA1010922510001Medicaid
PA7658428OtherAETNA-DR. MILLER
PA0018655130002Medicaid
PA7897615OtherAETNA-DR.MORRIS
PA039620Medicare ID - Type UnspecifiedMEDICARE-DR. MILLER
PA037425OtherBLUESHIELD-DR.MILLER
PAU81034Medicare UPIN
PA1010922510001Medicaid