Provider Demographics
NPI:1528154952
Name:PRATT, DAMIAN J (DC)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:J
Last Name:PRATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W COLORADO
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211
Mailing Address - Country:US
Mailing Address - Phone:214-943-4631
Mailing Address - Fax:214-946-5334
Practice Address - Street 1:2100 W COLORADO
Practice Address - Street 2:STEVENS PARK CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211
Practice Address - Country:US
Practice Address - Phone:214-943-4631
Practice Address - Fax:214-946-5334
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U95540Medicare UPIN
8B6617Medicare ID - Type Unspecified