Provider Demographics
NPI:1174631790
Name:NORTH TEXAS CLINIC & REHABILITATION CENTER, P.A.
Entity Type:Organization
Organization Name:NORTH TEXAS CLINIC & REHABILITATION CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-581-5959
Mailing Address - Street 1:PO BOX 48100
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-0100
Mailing Address - Country:US
Mailing Address - Phone:817-581-5959
Mailing Address - Fax:817-581-9231
Practice Address - Street 1:5750 RUFE SNOW DR
Practice Address - Street 2:STE 100
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6163
Practice Address - Country:US
Practice Address - Phone:817-581-5959
Practice Address - Fax:817-581-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX44KGOtherBLUE CROSS BLUE SHIELD