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General NPI Number Information
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NPI Number | 1649066366
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Entity Type | Individual
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Provider Name | BRODIE MICHAEL LEROY DC
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Gender | Male
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 5100 BELT LINE RD STE 1012
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City | DALLAS
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State | TX
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Zip | 75254-7031
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Country | US
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Telephone | 214-854-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 3336 CROSS BEND RD
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City | PLANO
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State | TX
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Zip | 75023-5700
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Country | US
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Telephone | 337-703-2401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 16157
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License Number State | TX
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