Provider Demographics
NPI:1386672376
Name:TRAXLER, MIKE (DC)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:TRAXLER
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 1:8600 LAKEVIEW PKWY
Mailing Address - Street 2:STE E
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4399
Mailing Address - Country:US
Mailing Address - Phone:972-412-1150
Mailing Address - Fax:972-412-1160
Practice Address - Street 1:8600 LAKEVIEW PKWY
Practice Address - Street 2:STE E
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4399
Practice Address - Country:US
Practice Address - Phone:972-412-1150
Practice Address - Fax:972-412-1160
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00934VOtherMEDICARE GROUP
TX00934VOtherMEDICARE GROUP
TXV05103Medicare UPIN