Premier Sports Chiropractic | |
6025 Royal Lane Suite 6051 Dallas TX 75230 | |
(214) 696-5100 | |
Not Available |
Full Name | Premier Sports Chiropractic |
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Speciality | Clinic/Center |
Location | 6025 Royal Lane, Dallas, Texas |
Authorized Official Name and Position | Lawrence Stephen Grimm (PRESIDENT AND OWNER) |
Authorized Official Contact | 2146965100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Premier Sports Chiropractic 6025 Royal Lane Suite 6051 Dallas TX 75230 Ph: (214) 696-5100 | Premier Sports Chiropractic 6025 Royal Lane Suite 6051 Dallas TX 75230 Ph: (214) 696-5100 |
NPI Number | 1952546889 |
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Provider Enumeration Date | 12/05/2008 |
Last Update Date | 02/03/2009 |
Medicare PECOS PAC ID | 2062579683 |
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Medicare Enrollment ID | O20090326000410 |
Identifier | Type | State | Issuer |
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1952546889 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 10863 (Texas) | Primary |
Provider Name | Lawrence S Grimm |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1861637621 PECOS PAC ID: 2961569587 Enrollment ID: I20090326000423 |
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