NPIMap

Organization Active NPI

Gemini Concepts, Inc

  • Chiropractor
  • Southlake, TX
National Provider Identifier
1194745943
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6658 Issued in TX
Legal business name
GEMINI CONCEPTS, INC
Practice address
680 N Carroll Ave
Suite 120
Southlake, TX 76092-6475
Phone
(817) 421-9111
Fax
(817) 421-9222
NPI assigned
Jul 21, 2006
Organization subpart
Yes
Parent organization
GEMINI CONCEPTS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Greg Davidovich, DCNPI 1649218777
Title
Owner/Provider
Phone
(817) 421-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 6658 TX Primary

Addresses

Primary practice location

680 N Carroll Ave
Suite 120
Southlake, TX 76092-6475

Mailing address

PO Box 92248
Southlake, TX 76092-0103
Phone (817) 421-9111

Other identifiers 1

IdentifierTypeStateIssuer
0005NDOtherTXBCBS

Other names 1

  • Back In Action Spinal Decompression Center Other name

National Provider Directory

National Provider Directory
Part of
Gemini Concepts Inc

Locations

700 E Southlake Blvd
Ste 130
Southlake, TX 76092
Phone (817) 328-0331

680 N Carroll Ave
Ste 120
Southlake, TX 76092
Phone (817) 421-9111

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1194745943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92248",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760920103",
            "telephone_number": "817-421-9111",
            "fax_number": "817-421-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 N CARROLL AVE",
            "address_2": "SUITE 120",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926475",
            "telephone_number": "817-421-9111",
            "fax_number": "817-421-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEMINI CONCEPTS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEMINI CONCEPTS, INC",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "DAVIDOVICH",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "817-421-9111",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "6658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0005ND",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back In Action Spinal Decompression Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.