Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 13375 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 13375 | TX |
NPI | 1225574155 |
---|---|
Provider Name | Dr. Jay Prahlad Bhakta |
First Address | Mansfield, TX 76063-5379 |
Second Address | Mansfield, TX 76063-5379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2017 |
Last Update Date | 07/04/2017 |