Provider Demographics
NPI:1841460441
Name:NORTH DALLAS INTEGRATED HEALTH
Entity type:Organization
Organization Name:NORTH DALLAS INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-789-1234
Mailing Address - Street 1:14444 DALLAS PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8304
Mailing Address - Country:US
Mailing Address - Phone:972-789-1234
Mailing Address - Fax:972-789-1589
Practice Address - Street 1:14444 DALLAS PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8304
Practice Address - Country:US
Practice Address - Phone:972-789-1234
Practice Address - Fax:972-789-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027JQOtherBCBS PIN