HEALTHSOURCE OF SOUTH LAKE LLC
NPI 1396025151
Chiropractor in Southlake, TX

Q: What is Healthsource Of South Lake LLC's NPI number?

The NPI number for Healthsource Of South Lake LLC is 1396025151. It was assigned to this organization in the NPPES registry on August 25, 2011.

Q: What is Healthsource Of South Lake LLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Active since August 25, 2011

2225 W SOUTHLAKE BLVD, SUITE 441, SOUTHLAKE, TX 76092(817) 310-0150(817) 310-0710 Get Directions Write a Review

NPPES record last updated: September 12, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Healthsource Of South Lake Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEALTHSOURCE OF SOUTH LAKE LLC (NPI 1396025151) is a healthcare organization registered as a chiropractor in Southlake, Texas and active in the NPI registry since August 2011. The organization lists M Brandon Pettke, Dc/manager, as its authorized official.

NPPES Registry Identity

NPI1396025151

Entity TypeOrganization

Primary Taxonomy111N00000X

Legal Business NameHEALTHSOURCE OF SOUTH LAKE LLC

Location Address2225 W SOUTHLAKE BLVD, SUITE 441Southlake, TX 76092-6750

Mailing Address2225 W Southlake Blvd, Suite 441Southlake, TX 76092-6750 · (817) 310-0150 · Fax (817) 310-0710

Phone(817) 310-0150

Fax(817) 310-0710

Organization SubpartNo

Authorized OfficialM Brandon PettkeDc/manager · (817) 310-0150

Enumeration DateAugust 25, 2011

Last NPPES UpdateSeptember 12, 2013

✔ NPI 1396025151 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers

Taxonomy Code111N00000X

Definition

A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

2225 W SOUTHLAKE BLVD, Southlake, TX 76092

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DIVERSIFIED DIAGNOSTICS

Clinical Medical Laboratory

2225 W SOUTHLAKE BLVD, SUITE 124
SOUTHLAKE, TX 76092

Tarrant County (817) 879-0962

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Healthsource Of South Lake LLC's NPI number?

The NPI number for Healthsource Of South Lake LLC is 1396025151. It was assigned to this organization in the NPPES registry on August 25, 2011.

Where is Healthsource Of South Lake LLC located?

Healthsource Of South Lake LLC is located at 2225 W Southlake Blvd Suite 441, Southlake, TX 76092. The listed phone number is (817) 310-0150.

What is Healthsource Of South Lake LLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

When was this NPI record last updated?

The NPPES record for Healthsource Of South Lake LLC was last updated on September 12, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.