Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 13903 | TX |
N | 111NP0017X | Pediatric Chiropractor | 13903 | TX |
NPI | 1063976843 |
---|---|
Provider Name | Alexandria R Pankoke |
First Address | Dallas, TX 75231-1099 |
Second Address | Dallas, TX 75231-1099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2019 |
Last Update Date | 26/01/2019 |