Provider Demographics
NPI:1841389293
Name:DR. BRIAN MULHALL, PA
Entity Type:Organization
Organization Name:DR. BRIAN MULHALL, PA
Other - Org Name:ACTIVE SPINE & SPORT THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MULHALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-332-5353
Mailing Address - Street 1:3600 HULEN ST
Mailing Address - Street 2:STE A4
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6863
Mailing Address - Country:US
Mailing Address - Phone:817-332-5353
Mailing Address - Fax:817-332-5358
Practice Address - Street 1:3600 HULEN ST
Practice Address - Street 2:STE A4
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6863
Practice Address - Country:US
Practice Address - Phone:817-332-5353
Practice Address - Fax:817-332-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10037111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1048450Medicare UPIN
TX8F0390Medicare ID - Type Unspecified