Provider Demographics
NPI:1770690166
Name:KUCERA, ERIC S (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:KUCERA
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 1:107 LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:VAN VLECK
Mailing Address - State:TX
Mailing Address - Zip Code:77482-9764
Mailing Address - Country:US
Mailing Address - Phone:979-335-4500
Mailing Address - Fax:979-335-4545
Practice Address - Street 1:1131 A MAIN
Practice Address - Street 2:
Practice Address - City:EAST BERNARD
Practice Address - State:TX
Practice Address - Zip Code:77435-9227
Practice Address - Country:US
Practice Address - Phone:979-335-4500
Practice Address - Fax:979-335-4545
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00379816OtherRR MEDICARE
TX605855OtherBCBS
TXDC7950OtherWC
TX8F1955Medicare PIN