Provider Demographics
NPI:1386654887
Name:BHATT, MAYANK A (DC)
Entity Type:Individual
Prefix:
First Name:MAYANK
Middle Name:A
Last Name:BHATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:A
Other - Last Name:BHATT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:300 BEARDSLEY LN
Mailing Address - Street 2:BLDG B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4945
Mailing Address - Country:US
Mailing Address - Phone:512-329-5500
Mailing Address - Fax:512-329-0170
Practice Address - Street 1:300 BEARDSLEY LN
Practice Address - Street 2:BLDG B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4945
Practice Address - Country:US
Practice Address - Phone:512-329-5500
Practice Address - Fax:512-329-0170
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU35630Medicare UPIN
TX87Y272Medicare ID - Type UnspecifiedMEDICARE NUMBER