Provider Demographics
NPI:1124273180
Name:DJD MANAGEMENT PC
Entity type:Organization
Organization Name:DJD MANAGEMENT PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-881-2225
Mailing Address - Street 1:105 E HUBBARD ST
Mailing Address - Street 2:PO BOX 385
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-3396
Mailing Address - Country:US
Mailing Address - Phone:903-526-2225
Mailing Address - Fax:903-881-9591
Practice Address - Street 1:105 E HUBBARD ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-3396
Practice Address - Country:US
Practice Address - Phone:903-881-2225
Practice Address - Fax:903-881-9591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX3092332BC3200X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6262820001Medicare NSC
TX0A3592Medicare PIN