Provider Demographics
NPI:1639135213
Name:BRECHTEL, MARY E (DC DACBN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BRECHTEL
Suffix:
Gender:F
Credentials:DC DACBN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:MALOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC DACBN
Mailing Address - Street 1:6825 STEWART RD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-1841
Mailing Address - Country:US
Mailing Address - Phone:409-744-2225
Mailing Address - Fax:
Practice Address - Street 1:6825 STEWART RD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-1841
Practice Address - Country:US
Practice Address - Phone:409-744-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8061111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7570OtherBLUECROSS BLUESHIELD
10619738OtherCAQH
TX2138188OtherAETNA-HMO
TX5596672OtherAETNA
TX5596672OtherAETNA
TXU72987Medicare UPIN
TX5894410001Medicare NSC
TX609181Medicare PIN
TX350046073Medicare PIN