Provider Demographics
NPI:1356762496
Name:FUNCTIONAL MOVEMENT CHIROPRACTIC
Entity type:Organization
Organization Name:FUNCTIONAL MOVEMENT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASA
Authorized Official - Middle Name:URIAN
Authorized Official - Last Name:HADSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-600-4336
Mailing Address - Street 1:1331 US HIGHWAY 80 E STE 10
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5709
Mailing Address - Country:US
Mailing Address - Phone:214-600-4336
Mailing Address - Fax:
Practice Address - Street 1:1331 US HIGHWAY 80 E STE 10
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5709
Practice Address - Country:US
Practice Address - Phone:214-600-4336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX081652111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548515430OtherNPI