Provider Demographics
NPI:1801071766
Name:MAGNOLIA PAIN MANAGEMENT
Entity type:Organization
Organization Name:MAGNOLIA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:MIRMINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-257-2525
Mailing Address - Street 1:PO BOX 165062
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-5062
Mailing Address - Country:US
Mailing Address - Phone:972-257-2525
Mailing Address - Fax:972-257-2527
Practice Address - Street 1:2001 W AIRPORT FWY STE 107
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6035
Practice Address - Country:US
Practice Address - Phone:972-257-2525
Practice Address - Fax:972-257-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty