Provider Demographics
NPI:1902028756
Name:DR. PENNY R. GARRISON, D.C., P.A.
Entity Type:Organization
Organization Name:DR. PENNY R. GARRISON, D.C., P.A.
Other - Org Name:ACTIVCARE CHIROPRACTIC OF DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-821-2525
Mailing Address - Street 1:6333 E MOCKINGBIRD LN
Mailing Address - Street 2:223
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2692
Mailing Address - Country:US
Mailing Address - Phone:214-821-2525
Mailing Address - Fax:214-821-2548
Practice Address - Street 1:6333 E MOCKINGBIRD LN
Practice Address - Street 2:223
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2692
Practice Address - Country:US
Practice Address - Phone:214-821-2525
Practice Address - Fax:214-821-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty