=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598984684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR BRIAN HOOTEN DC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2007
-----------------------------------------------------
Last Update Date | 02/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15340 DALLAS PKWY #2740
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-4636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-735-9005
-----------------------------------------------------
Fax | 972-735-9004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15340 DALLAS PKWY #2740
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-4636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-735-9005
-----------------------------------------------------
Fax | 972-735-9004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR BRIAN HOOTEN D.C
-----------------------------------------------------
Name | DR. BRIAN L HOOTEN
-----------------------------------------------------
Credential | D.C., B.S
-----------------------------------------------------
Telephone | 972-735-9005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 8772
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------