Provider Demographics
NPI:1225231715
Name:BRONSON CLINIC, INC.
Entity Type:Organization
Organization Name:BRONSON CLINIC, INC.
Other - Org Name:BRONSON CHIROPRACTIC HEALTH CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-732-4441
Mailing Address - Street 1:5521 BELLAIRE DR S STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5855
Mailing Address - Country:US
Mailing Address - Phone:817-732-4441
Mailing Address - Fax:817-732-2472
Practice Address - Street 1:5521 BELLAIRE DR S STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5855
Practice Address - Country:US
Practice Address - Phone:817-732-4441
Practice Address - Fax:817-732-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4065111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601484Medicare ID - Type Unspecified
TXT12385Medicare UPIN