Provider Demographics
NPI:1457605826
Name:ADVANCED MEDICAL PAIN& REHABILITATION CENTER
Entity Type:Organization
Organization Name:ADVANCED MEDICAL PAIN& REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MATISCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-302-2262
Mailing Address - Street 1:2600 ELDORADO PKWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4367
Mailing Address - Country:US
Mailing Address - Phone:972-540-6630
Mailing Address - Fax:972-540-0384
Practice Address - Street 1:2600 ELDORADO PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4367
Practice Address - Country:US
Practice Address - Phone:972-540-6630
Practice Address - Fax:972-540-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty