Provider Demographics
NPI:1285642702
Name:BRASWELL, JOHN BURTON (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BURTON
Last Name:BRASWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 SWEETWATER BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3126
Mailing Address - Country:US
Mailing Address - Phone:281-494-2225
Mailing Address - Fax:281-494-1133
Practice Address - Street 1:4665 SWEETWATER BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3126
Practice Address - Country:US
Practice Address - Phone:281-494-2225
Practice Address - Fax:281-494-1133
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017121-01Medicaid
TX8A2506Medicare ID - Type Unspecified
TX0017121-01Medicaid