Provider Demographics
NPI:1366899833
Name:CHIROHEALTH MEDICAL AND ANCILLARY SERVICES, LLC
Entity type:Organization
Organization Name:CHIROHEALTH MEDICAL AND ANCILLARY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MEE OK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:214-872-1232
Mailing Address - Street 1:4112 LEGACY DR
Mailing Address - Street 2:SUITE 326
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0810
Mailing Address - Country:US
Mailing Address - Phone:214-872-1232
Mailing Address - Fax:
Practice Address - Street 1:4112 LEGACY DR STE 326
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-0811
Practice Address - Country:US
Practice Address - Phone:214-872-1232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-15
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123278261QP2300X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care