Active NPI
Tellis D Broussard, D.C
- Chiropractor
- Pearland, TX
National Provider Identifier
1134566516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 12109
- Practice address
- 3102 Birch Landing CT
Pearland, TX 77584-6810 - Phone
- (832) 687-9404
- NPI assigned
- May 27, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 12109 | TX | Primary |
Addresses
Primary practice location
3102 Birch Landing CT
Pearland, TX 77584-6810
Mailing address
3102 Birch Landing CT
Pearland, TX 77584-6810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12109 | TX | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pinnacle Chiropractic & Wellness Center | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Pearland, TX
- NPI 1578947032
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369612800000",
"number": "1134566516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3102 BIRCH LANDING CT",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775846810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3102 BIRCH LANDING CT",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775846810",
"telephone_number": "832-687-9404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROUSSARD",
"first_name": "TELLIS",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-27",
"last_updated": "2013-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "TX",
"license": "12109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.