Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 2203 | TX |
NPI | 1598744526 |
---|---|
Provider Name | Dr. Walter Travis Brzozowske |
First Address | Victoria, TX 77904-2088 |
Second Address | Victoria, TX 77904-2088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T12440 | (02) | TX |