Healthsource of South Lake LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

HEALTHSOURCE OF SOUTH LAKE LLC

Practice address

2225 W Southlake Blvd
Suite 441
Southlake, TX 76092-6750

Phone

(817) 310-0150

Fax

(817) 310-0710

NPI assigned

Aug 25, 2011

Last updated

Sep 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. M Brandon Pettke, DC

Title

DC/Manager

Phone

(817) 310-0150

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Brandon Pettke, DC

  • Chiropractor
  • Burleson, TX
  • NPI 1730107889
  NPD (past)

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

{
    "created_epoch": "1314230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378944000000",
    "number": "1396025151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 W SOUTHLAKE BLVD",
            "address_2": "SUITE 441",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926750",
            "telephone_number": "817-310-0150",
            "fax_number": "817-310-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 W SOUTHLAKE BLVD",
            "address_2": "SUITE 441",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926750",
            "telephone_number": "817-310-0150",
            "fax_number": "817-310-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF SOUTH LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-25",
        "last_updated": "2013-09-12",
        "status": "A",
        "authorized_official_last_name": "PETTKE",
        "authorized_official_first_name": "M BRANDON",
        "authorized_official_title_or_position": "DC/MANAGER",
        "authorized_official_telephone_number": "817-310-0150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Healing Care Hospice Inc
• Health Imaging Partners, LLC (Dba Envision Imaging at South Lake)
• Health Matters Primary Care
• Healthcare Associates of Southlake LLP (Executive Medicine of Texas)
• Healthscripts of America-Southlake, LLC
• Healthtexas Provider Network
• Heard It Through the Grapevine Audiology, PC
• Heart and Vascular Medical Center of North Texas PLLC
• Lana M Heath, FNP
• Hebert Southlake Chiropractic

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.

Verify at the official NPI Registry.