Provider Demographics
NPI:1174753677
Name:OCCUCARE MEDICAL CENTERS PA
Entity type:Organization
Organization Name:OCCUCARE MEDICAL CENTERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:H
Authorized Official - Last Name:YSBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-731-2102
Mailing Address - Street 1:6789 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7112
Mailing Address - Country:US
Mailing Address - Phone:817-731-2101
Mailing Address - Fax:817-731-2157
Practice Address - Street 1:8100 JOHN W CARPENTER FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4721
Practice Address - Country:US
Practice Address - Phone:972-677-4895
Practice Address - Fax:972-677-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9831111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty