MEDICARE: DR. BRIAN C MULHALL D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	10037	TX

General Provider Information

NPI Number	:	1972562981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN C MULHALL D.C.

Provider Business Mailing Address
First Line	:	3600 HULEN ST
Second Line	:	STE A4
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6863
Country	:	US
Telephone Number	:	817-332-5353
Fax Number	:	817-332-5358

Provider Business Practice Location Address
First Line	:	3600 HULEN ST
Second Line	:	STE A4
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6863
Country	:	US
Telephone Number	:	817-332-5353
Fax Number	:	817-332-5358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	12/29/2012

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