Provider Demographics
NPI:1699533372
Name:BLACK, ELIZABETH (DC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 STATE HIGHWAY 121 STE 124
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2903
Mailing Address - Country:US
Mailing Address - Phone:972-625-4800
Mailing Address - Fax:972-625-5028
Practice Address - Street 1:4709 STATE HIGHWAY 121 STE 124
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2903
Practice Address - Country:US
Practice Address - Phone:972-625-4800
Practice Address - Fax:972-625-5028
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor