Provider Demographics
NPI:1740770353
Name:BAIN, DJORN GREG (DC)
Entity Type:Individual
Prefix:DR
First Name:DJORN
Middle Name:GREG
Last Name:BAIN
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 1:2313 W ARKANSAS LN STE 102
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6034
Mailing Address - Country:US
Mailing Address - Phone:817-900-2851
Mailing Address - Fax:817-549-3052
Practice Address - Street 1:2313 W ARKANSAS LN STE 102
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-6034
Practice Address - Country:US
Practice Address - Phone:817-900-2851
Practice Address - Fax:817-549-3052
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty