Provider Demographics
NPI:1760871982
Name:100 PERCENT CHIROPRACTIC DALLAS TWO, LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC DALLAS TWO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARNELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-222-4997
Mailing Address - Street 1:5100 BELT LINE RD STE 316
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7559
Mailing Address - Country:US
Mailing Address - Phone:469-222-4997
Mailing Address - Fax:
Practice Address - Street 1:5100 BELT LINE RD STE 316
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7559
Practice Address - Country:US
Practice Address - Phone:469-222-4997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12826111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty