Provider Demographics
NPI:1376860270
Name:FORTIER, JUSTIN ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ANTHONY
Last Name:FORTIER
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 1:7001 W PARKER RD
Mailing Address - Street 2:APARTMENT 534
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8614
Mailing Address - Country:US
Mailing Address - Phone:972-742-7912
Mailing Address - Fax:
Practice Address - Street 1:6350 LBJ FWY
Practice Address - Street 2:SUITE 166
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6403
Practice Address - Country:US
Practice Address - Phone:972-742-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-01
Last Update Date:2010-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11395111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician