Provider Demographics
NPI:1104244003
Name:100 PERCENT CHIROPRACTIC DALLAS ONE LLC
Entity type:Organization
Organization Name:100 PERCENT CHIROPRACTIC DALLAS ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-812-9906
Mailing Address - Street 1:7324 GASTON AVE # 118
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6126
Mailing Address - Country:US
Mailing Address - Phone:214-812-9906
Mailing Address - Fax:
Practice Address - Street 1:7324 GASTON AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214
Practice Address - Country:US
Practice Address - Phone:281-467-5381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007106111N00000X
TX12011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty