Provider Demographics
NPI:1134276462
Name:FERAGOTTI, BRIAN DOMINIC (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOMINIC
Last Name:FERAGOTTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 MAIN ST
Mailing Address - Street 2:SUITE 235-157
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4411
Mailing Address - Country:US
Mailing Address - Phone:214-727-8341
Mailing Address - Fax:214-383-9655
Practice Address - Street 1:3245 MAIN ST
Practice Address - Street 2:SUITE 235-157
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4411
Practice Address - Country:US
Practice Address - Phone:214-727-8341
Practice Address - Fax:214-383-9655
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8608OtherLICENSE