Provider Demographics
NPI:1982418521
Name:ARDISSONO, BRICE LEANNE
Entity type:Individual
Prefix:
First Name:BRICE
Middle Name:LEANNE
Last Name:ARDISSONO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 BUFFALO GAP RD STE D
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1263
Mailing Address - Country:US
Mailing Address - Phone:325-632-0586
Mailing Address - Fax:
Practice Address - Street 1:5849 BUFFALO GAP RD STE D
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-1263
Practice Address - Country:US
Practice Address - Phone:325-632-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor