Provider Demographics
NPI:1982738159
Name:SAUL, BRIAN RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RONALD
Last Name:SAUL
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 1:4634 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3744
Mailing Address - Country:US
Mailing Address - Phone:817-735-3839
Mailing Address - Fax:817-735-3837
Practice Address - Street 1:4634 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3744
Practice Address - Country:US
Practice Address - Phone:817-735-3839
Practice Address - Fax:817-735-3837
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9203111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U3647OtherBLUE CROSS BLUE SHIELD
TX5055041OtherCIGNA