1770823262 NPI number — ALLIED INJURY & WELLNESS CENTER, INC

Table of content: MS. DOMINIQUE NICCOLE ATKINS MSW LSW (NPI 1467819391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770823262 NPI number — ALLIED INJURY & WELLNESS CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIED INJURY & WELLNESS CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770823262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9304 FOREST LN
Provider Second Line Business Mailing Address:
S-226
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75243-6238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-503-9400
Provider Business Mailing Address Fax Number:
214-503-9401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9304 FOREST LN
Provider Second Line Business Practice Location Address:
S-226
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-6238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-503-9400
Provider Business Practice Location Address Fax Number:
214-503-9401
Provider Enumeration Date:
02/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OFURUM
Authorized Official First Name:
C KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
214-503-9400

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  9656 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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