| Rockwall Spine And Sports Medicine | |
|
1160 Horizon Rd Rockwall TX 75032-5498 | |
| (972) 722-8800 | |
| Not Available |
| Full Name | Rockwall Spine And Sports Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 1160 Horizon Rd, Rockwall, Texas |
| Authorized Official Name and Position | Jay Humphrey (OWNER) |
| Authorized Official Contact | 9727228800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockwall Spine And Sports Medicine 1160 Horizon Road Rockwall TX 75032 Ph: (972) 722-8800 | Rockwall Spine And Sports Medicine 1160 Horizon Rd Rockwall TX 75032-5498 Ph: (972) 722-8800 |
| NPI Number | 1407151897 |
|---|---|
| Provider Enumeration Date | 01/18/2011 |
| Last Update Date | 02/04/2014 |
| Medicare PECOS PAC ID | 2062699986 |
|---|---|
| Medicare Enrollment ID | O20110601000938 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407151897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 10730 (Texas) | Primary |
| Provider Name | Jay T Humphrey |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1972787992 PECOS PAC ID: 4880742212 Enrollment ID: I20090423000265 |
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