Provider Demographics
NPI:1578661047
Name:DOLEZAL, DAVID DWAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DWAYNE
Last Name:DOLEZAL
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:PO BOX 270967
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427
Mailing Address - Country:US
Mailing Address - Phone:361-852-4593
Mailing Address - Fax:361-852-0062
Practice Address - Street 1:5202 WEBER RD
Practice Address - Street 2:SUITE B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-852-4593
Practice Address - Fax:361-852-0062
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC06053311Medicaid
TXC06053311Medicaid
U57739Medicare UPIN