Provider Demographics
NPI:1649604380
Name:CARMACK CHIROPRACTIC AND SPORTS THERAPY
Entity type:Organization
Organization Name:CARMACK CHIROPRACTIC AND SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-262-9681
Mailing Address - Street 1:3700 RIVER WALK DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1812
Mailing Address - Country:US
Mailing Address - Phone:972-899-9818
Mailing Address - Fax:972-899-9819
Practice Address - Street 1:3700 RIVER WALK DR
Practice Address - Street 2:SUITE 165
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1812
Practice Address - Country:US
Practice Address - Phone:972-899-9818
Practice Address - Fax:972-899-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10941111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty