Organization
MEDCHIRO INJURY REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID LONG (ADMINISTRATOR)
(214) 865-9248
Entity
Organization
Contact information
Practice address
1619 MARTIN LUTHER KING JR BLVD, DALLAS, TX 75215
(214) 865-9248
Mailing address
PO BOX 195884, DALLAS, TX 75219-8615
(214) 865-9248
(469) 533-0307
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
F0011931
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F0011931
TEXAS BOARD OF CHIROPRACTIC EXAMINERS
TX
Enumeration date
06/02/2016
Last updated
03/09/2020
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