Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 14212 | TX |
NPI | 1134779416 |
---|---|
Provider Name | Dr. Pratik Soni |
First Address | Providence Village, TX 76227-1714 |
Second Address | Crossroads, TX 76227-8228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |