Provider Demographics
NPI:1548622442
Name:BLACKWELL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BLACKWELL CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:DALTON
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-363-5267
Mailing Address - Street 1:6039 SHERRY LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6402
Mailing Address - Country:US
Mailing Address - Phone:214-363-5267
Mailing Address - Fax:214-361-1656
Practice Address - Street 1:6039 SHERRY LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6402
Practice Address - Country:US
Practice Address - Phone:214-363-5267
Practice Address - Fax:214-361-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty