Provider Demographics
NPI:1447207501
Name:BRATCHER, WILLIAM XAVIER
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:XAVIER
Last Name:BRATCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0554
Mailing Address - Country:US
Mailing Address - Phone:903-561-5757
Mailing Address - Fax:903-561-7071
Practice Address - Street 1:2210 W GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0554
Practice Address - Country:US
Practice Address - Phone:903-561-6676
Practice Address - Fax:903-561-7071
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6197111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001707102Medicaid
TX001707102Medicaid
TXU-44020Medicare UPIN