Provider Demographics
NPI:1134779416
Name:SONI, PRATIK (DC)
Entity type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:
Last Name:SONI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 MYERS CT
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1714
Mailing Address - Country:US
Mailing Address - Phone:817-881-1551
Mailing Address - Fax:
Practice Address - Street 1:9930 US HIGHWAY 380
Practice Address - Street 2:
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-8228
Practice Address - Country:US
Practice Address - Phone:817-881-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14212111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician