Provider Demographics
NPI:1437461944
Name:DR. BRUCE E. AMASON, PA
Entity Type:Organization
Organization Name:DR. BRUCE E. AMASON, PA
Other - Org Name:BACK AND BODY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-436-9785
Mailing Address - Street 1:571 W MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3667
Mailing Address - Country:US
Mailing Address - Phone:972-436-9785
Mailing Address - Fax:972-436-6068
Practice Address - Street 1:571 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3667
Practice Address - Country:US
Practice Address - Phone:972-436-9785
Practice Address - Fax:972-436-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11489111N00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB130397Medicare PIN