Organization
HEALTHSOURCE OF SOUTH LAKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. M BRANDON PETTKE DC (DC/MANAGER)
(817) 310-0150
Entity
Organization
Contact information
Practice address
2225 W SOUTHLAKE BLVD, SUITE 441, SOUTHLAKE, TX 76092-6750
(817) 310-0150
(817) 310-0710
Mailing address
2225 W SOUTHLAKE BLVD, SUITE 441, SOUTHLAKE, TX 76092-6750
(817) 310-0150
(817) 310-0710
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
08/25/2011
Last updated
09/12/2013
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