Healthcare Provider Details

I. General information

NPI: 1841389293
Provider Name (Legal Business Name): DR. BRIAN MULHALL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 HULEN ST STE A4
FORT WORTH TX
76107-6863
US

IV. Provider business mailing address

3600 HULEN ST STE A4
FORT WORTH TX
76107-6863
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-5353
  • Fax: 817-332-5358
Mailing address:
  • Phone: 817-332-5353
  • Fax: 817-332-5358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number10037
License Number StateTX

VIII. Authorized Official

Name: DR. BRIAN C MULHALL
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 817-332-5353