Provider Demographics
NPI:1427168970
Name:CHIROSPORT SPECIALISTS OF DALLAS
Entity type:Organization
Organization Name:CHIROSPORT SPECIALISTS OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:VAN BIEZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ART, BPE
Authorized Official - Phone:972-239-0010
Mailing Address - Street 1:4950 BELT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6751
Mailing Address - Country:US
Mailing Address - Phone:972-239-0010
Mailing Address - Fax:
Practice Address - Street 1:4950 BELT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6751
Practice Address - Country:US
Practice Address - Phone:972-239-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7351111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7351OtherTEXAS MEDICAL LICENSE
TX0083499OtherBCBS BLUELINK NUMBER
TX8U9710OtherBCBS PROVIDER
TX8U9710OtherBCBS PROVIDER