Provider Demographics
NPI:1609146489
Name:CLEAR SCOLIOSIS CLINIC
Entity Type:Organization
Organization Name:CLEAR SCOLIOSIS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-350-7708
Mailing Address - Street 1:2618 ELECTRONIC LN
Mailing Address - Street 2:102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2618 ELECTRONIC LN
Practice Address - Street 2:102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-1216
Practice Address - Country:US
Practice Address - Phone:214-350-7708
Practice Address - Fax:214-350-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11497111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty