Brace Chiropractic and Wellness Center LLC
Organization Active NPI Chiropractor · Azle, TX
NPI 1013196997 · NPPES record last updated Jun 29, 2015
Key facts
- NPI
- 1013196997
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 9732 (TX)
- Legal business name
- BRACE CHIROPRACTIC AND WELLNESS CENTER LLC
- Practice address
- 237 W Main St
Azle, TX 76020-3177 - Phone
- (817) 444-2170
- Fax
- (817) 270-3338
- NPI assigned
- Oct 29, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Jessica Polk Brace, DC
- Title
- Owner
- Phone
- (817) 444-2170
Practitioners 2
-
Matthew Alton Mishio, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041119000911 | TX | Part B Supplier - Clinic/Group Practice | 8527023464 |
Receives reassigned benefits from 2 practitioners Practice locations: Azle, TX |
National Provider Directory
Locations
237 W Main St
Azle, TX 76020
Phone (817) 444-2170
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 9732 | TX | Yes |
Addresses
Primary practice location
237 W Main St
Azle, TX 76020-3177
Mailing address
237 W Main St
Azle, TX 76020-3177
Phone (817) 444-2170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8R3130 | Other | TX | BLUE CROSS BLUE SHIELD |
Other providers in Azle, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.