Provider Demographics
NPI:1992077853
Name:DR BRIAN HOOTEN DC PA
Entity type:Organization
Organization Name:DR BRIAN HOOTEN DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-735-9005
Mailing Address - Street 1:15340 DALLAS PKWY
Mailing Address - Street 2:#2740
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4636
Mailing Address - Country:US
Mailing Address - Phone:972-735-9005
Mailing Address - Fax:
Practice Address - Street 1:15340 DALLAS PKWY
Practice Address - Street 2:#2740
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4636
Practice Address - Country:US
Practice Address - Phone:972-735-9005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty