Provider Demographics
NPI:1750302618
Name:ACCIDENT & REHAB CENTER
Entity Type:Organization
Organization Name:ACCIDENT & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:SOBERANIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-902-8868
Mailing Address - Street 1:3456 WEBB CHAPEL EXT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-6751
Mailing Address - Country:US
Mailing Address - Phone:214-902-8868
Mailing Address - Fax:214-902-9796
Practice Address - Street 1:3456 WEBB CHAPEL EXT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-6751
Practice Address - Country:US
Practice Address - Phone:214-902-8868
Practice Address - Fax:214-902-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty