Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8061 | TX |
N | 111NN1001X | Nutrition | 8061 | TX |
NPI | 1639135213 |
---|---|
Provider Name | Mary E Brechtel |
First Address | Galveston, TX 77551-1841 |
Second Address | Galveston, TX 77551-1841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 06/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10619738 | CAQH (01) | |
2138188 | AETNA-HMO (01) | TX |
5596672 | AETNA (01) | TX |
8S7570 | BLUECROSS BLUESHIELD (01) | TX |
U72987 | (02) | TX |