Provider Demographics
NPI:1679233753
Name:EDNIE, BRETT (DC)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:
Last Name:EDNIE
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 1:6211 W NORTHWEST HIGHWAY
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225
Mailing Address - Country:US
Mailing Address - Phone:972-996-2420
Mailing Address - Fax:469-941-0634
Practice Address - Street 1:6211 W NORTHWEST HIGHWAY
Practice Address - Street 2:SUITE C-100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:972-996-2420
Practice Address - Fax:469-941-0634
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor