Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 12064 | TX |
NPI | 1285984906 |
---|---|
Provider Name | Tankiso Katleho Mochache |
First Address | Grand Prairie, TX 75052-8136 |
Second Address | Grand Prairie, TX 75052-8136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 17/07/2013 |