Provider Demographics
NPI:1306862131
Name:AMASON, BRUCE ELLIS (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ELLIS
Last Name:AMASON
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 1:487 CROCKETT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3653
Mailing Address - Country:US
Mailing Address - Phone:972-436-9785
Mailing Address - Fax:972-436-6068
Practice Address - Street 1:487 CROCKETT
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3653
Practice Address - Country:US
Practice Address - Phone:972-436-9785
Practice Address - Fax:972-436-6068
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2830OtherSTATE LICENSE NO.(CHIRO)
CO3631OtherSTATE LICENSE NO. (CHIRO)
TX601108Medicare ID - Type UnspecifiedMEDICARE ID
TX2830OtherSTATE LICENSE NO.(CHIRO)