Healthcare Provider Details

I. General information

NPI: 1134779416
Provider Name (Legal Business Name): PRATIK SONI D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 US HIGHWAY 380
CROSSROADS TX
76227-8228
US

IV. Provider business mailing address

6022 MYERS CT
PROVIDENCE VILLAGE TX
76227-1714
US

V. Phone/Fax

Practice location:
  • Phone: 817-881-1551
  • Fax:
Mailing address:
  • Phone: 817-881-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number14212
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: