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General NPI Number Information
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NPI Number | 1215055058
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE CHIROPRACTIC PA
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 1321 WATERS EDGE DR STE 1003
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City | GRANBURY
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State | TX
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Zip | 76048-1233
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Country | US
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Telephone | 817-573-0500
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Fax | 817-573-0501
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Provider Business Mailing Address
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Address Line | 1321 WATERS EDGE DR STE 1003
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City | GRANBURY
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State | TX
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Zip | 76048-1232
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Country | US
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Telephone | 817-573-0500
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Fax | 817-573-0501
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH PAUL BRASSIE
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Credential | D.C.
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Telephone | 817-573-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 10149
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License Number State | TX
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