Basic Information
| Provider Information | |||||||||
| NPI: | 1831606722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE HEALTH MEDICAL CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15110 DALLAS PKWY STE 630 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752484635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727920204 | ||||||||
| FaxNumber: | 9727920290 | ||||||||
| Practice Location | |||||||||
| Address1: | 15110 DALLAS PKWY STE 630 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752484635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727920204 | ||||||||
| FaxNumber: | 9727920204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2018 | ||||||||
| LastUpdateDate: | 01/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOWINGTON | ||||||||
| AuthorizedOfficialFirstName: | SHELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5807755857 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 09927 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 208D00000X | Q9070 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.