Provider Demographics
NPI:1982718987
Name:BACK ICU PLLC
Entity Type:Organization
Organization Name:BACK ICU PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPEECE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-321-8887
Mailing Address - Street 1:10534 GARLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2637
Mailing Address - Country:US
Mailing Address - Phone:214-321-8887
Mailing Address - Fax:214-321-4329
Practice Address - Street 1:10534 GARLAND RD STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2637
Practice Address - Country:US
Practice Address - Phone:214-321-8887
Practice Address - Fax:214-321-4329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation