Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 14887 | TX |
Y | 111NP0017X | Pediatric Chiropractor | 14887 | TX |
NPI | 1659041309 |
---|---|
Provider Name | Dr. Brandy Simmons |
First Address | Richardson, TX 75081-2980 |
Second Address | Dallas, TX 75252-5475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |