Organization
ICONIQ SPINE & ORTHOPAEDIC CENTER PLLC
Active
Other names
Holistiq Spine & Orthopaedic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TRUNG HA MD (CEO)
(469) 444-7246
Entity
Organization
Contact information
Practice address
4441 W AIRPORT FWY STE 215, IRVING, TX 75062-5959
(469) 444-7246
(469) 440-2667
Mailing address
4441 W AIRPORT FWY STE 215, IRVING, TX 75062-5959
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780936971
CASH
TX
Enumeration date
01/26/2023
Last updated
05/09/2024
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