Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 11291 | TX |
NPI | 1093045122 |
---|---|
Provider Name | Dr. Michael Dan Lopez |
First Address | Frisco, TX 75034 |
Second Address | Carrollton, TX 75006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 18/09/2017 |