Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 12490 | TX |
NPI | 1225458730 |
---|---|
Provider Name | Brian Mann |
First Address | Dallas, TX 75244-4629 |
Second Address | Dallas, TX 75244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 20/06/2018 |