Provider Demographics
NPI:1013778794
Name:CHIRO CONNECT INJURY REHAB LLC
Entity Type:Organization
Organization Name:CHIRO CONNECT INJURY REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHADANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-358-7991
Mailing Address - Street 1:225 HAPPY LN
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8858
Mailing Address - Country:US
Mailing Address - Phone:469-358-7991
Mailing Address - Fax:
Practice Address - Street 1:285 N INTERSTATE 35 E
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5299
Practice Address - Country:US
Practice Address - Phone:469-613-4452
Practice Address - Fax:469-898-4313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty