MEDICARE: DR. BRIAN MULHALL, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	10037	TX

General Provider Information

NPI Number	:	1841389293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. BRIAN MULHALL, PA

Provider Business Mailing Address
First Line	:	3600 HULEN ST
Second Line	:	STE A4
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6863
Country	:	US
Telephone Number	:	817-332-5353
Fax Number	:	817-332-5358

Provider Business Practice Location Address
First Line	:	3600 HULEN ST
Second Line	:	STE A4
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6863
Country	:	US
Telephone Number	:	817-332-5353
Fax Number	:	817-332-5358

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. BRIAN C MULHALL
Credential	:	DC
Telephone Number	:	817-332-5353

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/29/2012

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