Provider Demographics
NPI:1730696956
Name:365 SPINE CARE OF NORTH TEXAS, PLLC
Entity type:Organization
Organization Name:365 SPINE CARE OF NORTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CARLL
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:469-693-0165
Mailing Address - Street 1:8080 INDEPENDENCE PKWY STE 230
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4013
Mailing Address - Country:US
Mailing Address - Phone:469-693-0165
Mailing Address - Fax:
Practice Address - Street 1:8080 INDEPENDENCE PKWY STE 230
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4013
Practice Address - Country:US
Practice Address - Phone:469-693-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN6843207X00000X
TXM8573207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty