Most Relevant Information
Provider Data
| NPI Number: | 1003009580 |
| Provider Name: | MIMI SONG IDICULA NP |
| Entity Type: | Individual |
| Taxonomy Code: | 111N00000X |
| Specialty: | Chiropractor |
| License Number: | 10049 |
Most Important Dates
| Enumeration Date: | 08/20/2007 |
| Last Updated: | 07/13/2021 |
Provider Practice Location
6161 N STATE HIGHWAY 161
IRVING
TX
750382220
Practice Location Phone/Fax
| Phone: | 9722587499 |
| Fax: | 9722570897 |
Provider Mailing Location
6161 N STATE HIGHWAY 161
IRVING
TX
750382220
Provider Mailing Phone/Fax
| Phone: | 9722587499 |
| Fax: | 9722570897 |