Provider Demographics
NPI:1265068936
Name:METROPLEX SPINAL & SPORTS CHIROPRACTIC, LTD.
Entity type:Organization
Organization Name:METROPLEX SPINAL & SPORTS CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARTUCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-725-8889
Mailing Address - Street 1:1804 FIRENZE ST
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76262-8036
Mailing Address - Country:US
Mailing Address - Phone:817-725-8889
Mailing Address - Fax:
Practice Address - Street 1:501 TROPHY LAKE DR
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5222
Practice Address - Country:US
Practice Address - Phone:817-725-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty