Provider Demographics
NPI:1184068538
Name:CARROLLTON INJURY REHAB
Entity type:Organization
Organization Name:CARROLLTON INJURY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALFORD
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-576-3136
Mailing Address - Street 1:2008 E HEBRON PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1601
Mailing Address - Country:US
Mailing Address - Phone:972-428-3905
Mailing Address - Fax:972-428-3910
Practice Address - Street 1:2008 E HEBRON PKWY STE 130
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1601
Practice Address - Country:US
Practice Address - Phone:972-428-3905
Practice Address - Fax:972-428-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-28
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0010373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty