# DICKERSON DALLAS PAIN ON PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134681349
- **Authorized official:** DAVID JANWAY LPC (COO)
- **Authorized official phone:** (972) 850-9179

## Contact information

- **Practice address:** 1675 REPUBLIC PKWY STE 201, MESQUITE, TX 75150-6902
- **Practice address phone:** (972) 850-9179
- **Practice address fax:** (877) 720-5614
- **Mailing address:** 1675 REPUBLIC PKWY, STE 201, MESQUITE, TX 75150-6902
- **Mailing address phone:** (713) 355-1500
- **Mailing address fax:** (713) 629-1945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/05/2019
- **Last updated:** 02/04/2021