NPIMap

Organization Active NPI

Victory Chiropractic and Physical Therapy

  • Chiropractor
  • Southlake, TX
National Provider Identifier
1790038693
Registry record updated Oct 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
9184 Issued in TX
Legal business name
VICTORY CHIROPRACTIC AND PHYSICAL THERAPY
Practice address
200 E Southlake Blvd
Suite 10
Southlake, TX 76092-6238
Phone
(817) 251-6767
Fax
(817) 251-6868
NPI assigned
Oct 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2012

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

Authorized official

Name
Brian Nimphius, DCNPI 1477735041
Title
Owner
Phone
(817) 251-6767

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: 193400000X SINGLE SPECIALTY GROUP 111N00000X 9184 TX Primary

Addresses

Primary practice location

200 E Southlake Blvd
Suite 10
Southlake, TX 76092-6238

Mailing address

200 E Southlake Blvd
Suite 10
Southlake, TX 76092-6238
Phone (817) 251-6767

Other identifiers 1

IdentifierTypeStateIssuer
607138OtherTXBCBS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1790038693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E SOUTHLAKE BLVD",
            "address_2": "SUITE 10",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926238",
            "telephone_number": "817-251-6767",
            "fax_number": "817-251-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E SOUTHLAKE BLVD",
            "address_2": "SUITE 10",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926238",
            "telephone_number": "817-251-6767",
            "fax_number": "817-251-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY CHIROPRACTIC AND PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-17",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "NIMPHIUS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-251-6767",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "9184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "607138",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 17, 2012; 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.