Provider Demographics
NPI:1598744526
Name:BRZOZOWSKE, WALTER TRAVIS (D C, FACO)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:TRAVIS
Last Name:BRZOZOWSKE
Suffix:
Gender:M
Credentials:D C, FACO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2088
Mailing Address - Country:US
Mailing Address - Phone:361-578-3594
Mailing Address - Fax:361-575-8184
Practice Address - Street 1:609 E MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2088
Practice Address - Country:US
Practice Address - Phone:361-578-3594
Practice Address - Fax:361-575-8184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2203111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12440Medicare UPIN
TX600030Medicare ID - Type Unspecified