Healthcare Provider Details

I. General information

NPI: 1508377177
Provider Name (Legal Business Name): BRAINDC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 SUNDERLAND LN
LEWISVILLE TX
75067-6716
US

IV. Provider business mailing address

2452 SUNDERLAND LN
LEWISVILLE TX
75067-6716
US

V. Phone/Fax

Practice location:
  • Phone: 972-304-9146
  • Fax:
Mailing address:
  • Phone: 972-304-9146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number5455
License Number StateTX

VIII. Authorized Official

Name: DR. MICHAEL W HALL
Title or Position: CHIROPRACTOR NEUROLOGIST
Credential: DC
Phone: 972-304-9146