Provider Demographics
NPI:1992002521
Name:NEW GRAND PRAIRIE CHIROPRACTIC
Entity Type:Organization
Organization Name:NEW GRAND PRAIRIE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-237-5660
Mailing Address - Street 1:1101 N.CARRIER PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-3382
Mailing Address - Country:US
Mailing Address - Phone:972-237-5660
Mailing Address - Fax:972-237-1482
Practice Address - Street 1:1101 N CARRIER PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3382
Practice Address - Country:US
Practice Address - Phone:972-237-5660
Practice Address - Fax:972-237-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty