Provider Demographics
NPI:1437912383
Name:BRASSIE, JUSTIN W (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:W
Last Name:BRASSIE
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 1:1321 WATERS EDGE DR STE 1003
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1233
Mailing Address - Country:US
Mailing Address - Phone:817-573-0500
Mailing Address - Fax:817-573-0501
Practice Address - Street 1:1321 WATERS EDGE DR STE 1003
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1233
Practice Address - Country:US
Practice Address - Phone:817-573-0500
Practice Address - Fax:817-573-0501
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor