Provider Demographics
NPI:1659542355
Name:BHAKTA, PRAKASH BHARAT (DC)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:BHARAT
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 REGENCY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5379
Mailing Address - Country:US
Mailing Address - Phone:817-453-0430
Mailing Address - Fax:817-453-0400
Practice Address - Street 1:221 REGENCY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5379
Practice Address - Country:US
Practice Address - Phone:817-453-0430
Practice Address - Fax:817-453-0400
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10852111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21815Medicare PIN
TX468043ZP1YMedicare PIN