Provider Demographics
NPI:1083899207
Name:CHIROPRACTIC OF COPPELL
Entity type:Organization
Organization Name:CHIROPRACTIC OF COPPELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALE
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:MACZIEWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:972-393-2447
Mailing Address - Street 1:580 S DENTON TAP RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4098
Mailing Address - Country:US
Mailing Address - Phone:972-393-2447
Mailing Address - Fax:972-393-4153
Practice Address - Street 1:580 S DENTON TAP RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4098
Practice Address - Country:US
Practice Address - Phone:972-393-2447
Practice Address - Fax:972-393-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10535261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center