1598744526 NPI number — DR. WALTER TRAVIS BRZOZOWSKE D. C., F.A.C.O.

Table of content: CAROL ANN JOHNS PT, CLT/LANA (NPI 1710498522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598744526 NPI number — DR. WALTER TRAVIS BRZOZOWSKE D. C., F.A.C.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRZOZOWSKE
Provider First Name:
WALTER
Provider Middle Name:
TRAVIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D. C., F.A.C.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598744526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 E MOCKINGBIRD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77904-2088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-578-3594
Provider Business Mailing Address Fax Number:
361-575-8184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 E MOCKINGBIRD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77904-2088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-578-3594
Provider Business Practice Location Address Fax Number:
361-575-8184
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NX0800X , with the licence number:  2203 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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