Provider Demographics
NPI:1669695748
Name:BACK PAIN INSTITUTE OF DALLAS
Entity type:Organization
Organization Name:BACK PAIN INSTITUTE OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC REHAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-239-7246
Mailing Address - Street 1:12200 PARK CENTRAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2116
Mailing Address - Country:US
Mailing Address - Phone:972-239-7246
Mailing Address - Fax:972-239-1889
Practice Address - Street 1:12200 PARK CENTRAL DR STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2116
Practice Address - Country:US
Practice Address - Phone:972-239-7246
Practice Address - Fax:972-239-1889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5636111N00000X
TX6788111NR0400X
TXJ0908207LP2900X
TX111742225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Not Answered225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty