Provider Demographics
NPI:1003367731
Name:PRUNTY, TAMIKIA LATRAY (DC)
Entity type:Individual
Prefix:DR
First Name:TAMIKIA
Middle Name:LATRAY
Last Name:PRUNTY
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 1:2022 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5435
Mailing Address - Country:US
Mailing Address - Phone:972-294-9642
Mailing Address - Fax:
Practice Address - Street 1:1930 E ROSEMEADE PKWY STE 204
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2468
Practice Address - Country:US
Practice Address - Phone:972-395-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13247111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner