Provider Demographics
NPI:1750842373
Name:ANNAS, MARY BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY BETH
Middle Name:
Last Name:ANNAS
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 1:590 N KIMBALL AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6888
Mailing Address - Country:US
Mailing Address - Phone:817-778-9200
Mailing Address - Fax:
Practice Address - Street 1:590 N KIMBALL AVE STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6888
Practice Address - Country:US
Practice Address - Phone:817-778-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor