Provider Demographics
NPI:1932489697
Name:HEALTHSOURCE OF MANSFIELD TEXAS LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE OF MANSFIELD TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-614-2963
Mailing Address - Street 1:121 W DEBBIE LN
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8941
Mailing Address - Country:US
Mailing Address - Phone:682-518-9393
Mailing Address - Fax:
Practice Address - Street 1:121 W DEBBIE LN
Practice Address - Street 2:SUITE 115
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8941
Practice Address - Country:US
Practice Address - Phone:682-518-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty