Provider Demographics
NPI:1053558148
Name:PORTER, BRIAN J (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:PORTER
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 1:700 RIO GRANDE ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:744 W WILLIAM CANNON DR
Practice Address - Street 2:#3003
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3181
Practice Address - Country:US
Practice Address - Phone:512-707-8970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor