Provider Demographics
NPI:1447337613
Name:BRASSIE, KENNETH PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PAUL
Last Name:BRASSIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E HIGHWAY 377
Mailing Address - Street 2:STE. #114
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1456
Mailing Address - Country:US
Mailing Address - Phone:817-573-0500
Mailing Address - Fax:817-573-0501
Practice Address - Street 1:1030 E HIGHWAY 377
Practice Address - Street 2:STE. #114
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1456
Practice Address - Country:US
Practice Address - Phone:817-573-0500
Practice Address - Fax:817-573-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX628577OtherPHCS
TX0067MYOtherBCBS GROUP #
TX8F1781OtherMEDICARE INDIVIDUAL
TX8U4210OtherBCBS INDIVIDUAL #
TX0067MYOtherBCBS GROUP #