Healthcare Provider Details

I. General information

NPI: 1952728545
Provider Name (Legal Business Name): BRANDON NUTT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 W NORTHWEST HWY STE C159
DALLAS TX
75225-3452
US

IV. Provider business mailing address

5732 HARVEST HILL RD
DALLAS TX
75230-1253
US

V. Phone/Fax

Practice location:
  • Phone: 469-855-5137
  • Fax:
Mailing address:
  • Phone: 469-855-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number12535
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number12535
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number12535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: