Provider Demographics
NPI:1760834055
Name:TABASSUM ALI CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:TABASSUM ALI CHIROPRACTIC CORPORATION
Other - Org Name:LONE STAR SPORT AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TABASSUM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-379-7993
Mailing Address - Street 1:2501 E HEBRON PKWY
Mailing Address - Street 2:#150
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4468
Mailing Address - Country:US
Mailing Address - Phone:972-379-7993
Mailing Address - Fax:
Practice Address - Street 1:2501 E HEBRON PKWY
Practice Address - Street 2:#150
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4468
Practice Address - Country:US
Practice Address - Phone:972-379-7993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12243305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0011898OtherFACILITY REGISTRATION NUMBER