Sidney Pruitt IV, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

13505 Issued in TX

Practice address

103 E Lone Star Ave
Cleburne, TX 76031-3226

Phone

(817) 645-8116

NPI assigned

Jun 2, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Pruitt Chiropractic PLLC

  • Chiropractor
  • Cleburne, TX
  • NPI 1285205005
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496361600000",
    "number": "1205364320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 E LONE STAR AVE",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760313226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 E LONE STAR AVE",
            "city": "CLEBURNE",
            "state": "TX",
            "postal_code": "760313226",
            "telephone_number": "817-645-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "SIDNEY",
        "name_suffix": "IV",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-02",
        "last_updated": "2017-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "13505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger Lane Poole, M.A., M.ED., LPC
• Samantha Powers, AUD
• Zoey Grace Prater
• Procare Home Care Services Unlimited, Corp
• Pruitt Chiropractic PLLC
• Sidney Charles Pruitt III, DC
• Psych Counseling Services, PLLC
• Pulse Medical Lab LLC
• Grethe Michelle Quiej
• Constance Marie Rafailedes, M.A., L.P.C., R.P.T.

• Chiropractor in Cleburne, TX
• Providers in Cleburne, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.