Provider Demographics
NPI:1427354711
Name:DJD MANAGEMENT PC
Entity type:Organization
Organization Name:DJD MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-526-2225
Mailing Address - Street 1:3347 OLD JACKSONVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7522
Mailing Address - Country:US
Mailing Address - Phone:903-526-2225
Mailing Address - Fax:903-526-2413
Practice Address - Street 1:3103 SE MILITARY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3801
Practice Address - Country:US
Practice Address - Phone:210-298-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3592Medicare PIN