Provider Demographics
NPI:1497886295
Name:BULLITT CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:BULLITT CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BULLITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-387-4321
Mailing Address - Street 1:7151 PRESTON RD
Mailing Address - Street 2:SUITE 111A
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5822
Mailing Address - Country:US
Mailing Address - Phone:214-387-4321
Mailing Address - Fax:214-387-4320
Practice Address - Street 1:7151 PRESTON RD
Practice Address - Street 2:SUITE 111A
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5822
Practice Address - Country:US
Practice Address - Phone:214-387-4321
Practice Address - Fax:214-387-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU97321Medicare UPIN
TX00820VMedicare PIN