| NPI | 1053036764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARCHESE Credentialing Manager 214-205-4995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-10-05 |