Provider Demographics
NPI:1932394574
Name:SSC CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:SSC CHIROPRACTIC, P.A.
Other - Org Name:SPINAL SPECIALIST CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:TAN VIET
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-416-5873
Mailing Address - Street 1:PO BOX 112624
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75011-2624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3109 N BELT LINE RD
Practice Address - Street 2:SUITE 138
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6867
Practice Address - Country:US
Practice Address - Phone:972-252-5873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9363111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty