Provider Demographics
NPI:1639930316
Name:BARTLETT, KACI D (DC)
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:D
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 RIDGE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-1100
Mailing Address - Country:US
Mailing Address - Phone:972-722-0054
Mailing Address - Fax:
Practice Address - Street 1:4210 RIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-1100
Practice Address - Country:US
Practice Address - Phone:972-722-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor