Provider Demographics
NPI:1225574155
Name:BHAKTA, JAY PRAHLAD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:PRAHLAD
Last Name:BHAKTA
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 1:221 REGENCY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5379
Mailing Address - Country:US
Mailing Address - Phone:817-453-0430
Mailing Address - Fax:817-453-0400
Practice Address - Street 1:221 REGENCY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5379
Practice Address - Country:US
Practice Address - Phone:817-453-0430
Practice Address - Fax:817-453-0400
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13375111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX558346ZP1YMedicare PIN
TX558346YQ2XMedicare PIN