Basic Information
| Provider Information | |||||||||
| NPI: | 1164902409 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DNA MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3736 BEE CAVES RD STE 9 | ||||||||
| Address2: | |||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123478881 | ||||||||
| FaxNumber: | 5123478882 | ||||||||
| Practice Location | |||||||||
| Address1: | 3736 BEE CAVES RD STE 9 | ||||||||
| Address2: | |||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123478881 | ||||||||
| FaxNumber: | 5123478882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | CORBETT | ||||||||
| AuthorizedOfficialFirstName: | BRANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5123478881 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 2081S0010X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | 208VP0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10195 | 01 | TX | CHIROPRACTOR | OTHER | Q7641 | 01 | TX | FAMILY MEDICINE | OTHER |