Provider Demographics
NPI:1104161637
Name:NOMPONE ENTERPRISES LLC
Entity type:Organization
Organization Name:NOMPONE ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOMPONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-442-6797
Mailing Address - Street 1:6120 CRESTMERE LN
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-5547
Mailing Address - Country:US
Mailing Address - Phone:469-442-6797
Mailing Address - Fax:
Practice Address - Street 1:730 E PARK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8850
Practice Address - Country:US
Practice Address - Phone:972-881-7272
Practice Address - Fax:972-516-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX278746Medicare PIN