Provider Demographics
NPI:1679165518
Name:TAMIKIA L PRUNTY LLC
Entity Type:Organization
Organization Name:TAMIKIA L PRUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMIKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-294-9642
Mailing Address - Street 1:2022 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5435
Mailing Address - Country:US
Mailing Address - Phone:972-294-9642
Mailing Address - Fax:
Practice Address - Street 1:1930 E ROSEMEADE PKWY STE 204
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2468
Practice Address - Country:US
Practice Address - Phone:972-395-9350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty