Provider Demographics
NPI:1801035191
Name:DORMAN BEND LP
Entity Type:Organization
Organization Name:DORMAN BEND LP
Other - Org Name:CUNNINGHAM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRYCE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-248-9592
Mailing Address - Street 1:115 SUNDANCE PKWY STE 340
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7840
Mailing Address - Country:US
Mailing Address - Phone:512-248-9592
Mailing Address - Fax:
Practice Address - Street 1:115 SUNDANCE PKWY STE 340
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7840
Practice Address - Country:US
Practice Address - Phone:512-248-9592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0059MCOtherBC BS OF TEXAS