Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 13999 | TX |
NPI | 1013481134 |
---|---|
Provider Name | Brennan J Riche' |
First Address | Anna, TX 75409-5073 |
Second Address | Grapevine, TX 76051-7359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2019 |
Last Update Date | 05/03/2019 |