Provider Demographics
NPI:1083328207
Name:PRATT, MASON TAYLOR (DC)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:TAYLOR
Last Name:PRATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 MERRIEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3353
Mailing Address - Country:US
Mailing Address - Phone:724-833-7718
Mailing Address - Fax:
Practice Address - Street 1:315 PAGE RD N STE 11
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-0087
Practice Address - Country:US
Practice Address - Phone:910-295-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5530111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902975865OtherCHIROPRACTIC