1649279738 NPI number — DR. BRIAN ANTHONY BULLITT D.C.

Table of content: DR. BRIAN ANTHONY BULLITT D.C. (NPI 1649279738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649279738 NPI number — DR. BRIAN ANTHONY BULLITT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLITT
Provider First Name:
BRIAN
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649279738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/24/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7151 PRESTON RD
Provider Second Line Business Mailing Address:
SUITE 111A
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-5822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-387-4321
Provider Business Mailing Address Fax Number:
214-387-4320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7151 PRESTON RD
Provider Second Line Business Practice Location Address:
SUITE 111A
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-5822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-387-4321
Provider Business Practice Location Address Fax Number:
214-387-4320
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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