Provider Demographics
NPI:1669797460
Name:BULLARD CHIROPRACTIC
Entity type:Organization
Organization Name:BULLARD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE-PARYS
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-894-3176
Mailing Address - Street 1:51633 US HIGHWAY 69 N
Mailing Address - Street 2:
Mailing Address - City:BULLARD
Mailing Address - State:TX
Mailing Address - Zip Code:75757-5546
Mailing Address - Country:US
Mailing Address - Phone:903-894-3176
Mailing Address - Fax:
Practice Address - Street 1:51633 US HIGHWAY 69 N
Practice Address - Street 2:
Practice Address - City:BULLARD
Practice Address - State:TX
Practice Address - Zip Code:75757-5546
Practice Address - Country:US
Practice Address - Phone:903-894-3176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty