Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 7351 | TX |
NPI | 1235270679 |
---|---|
Provider Name | Dr. Troy Curtis Van Biezen |
First Address | Dallas, TX 75254-6751 |
Second Address | Dallas, TX 75254-6751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7351 | STATE MEDICAL LICENSE (01) | TX |
8U9710 | BCBS PROVIDER ID (01) | TX |