Provider Demographics
NPI:1790051472
Name:BUFFALOHEAD, BRET (DC)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:BUFFALOHEAD
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 1:2136 YALE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008
Mailing Address - Country:US
Mailing Address - Phone:832-668-5974
Mailing Address - Fax:832-668-5984
Practice Address - Street 1:2136 YALE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2528
Practice Address - Country:US
Practice Address - Phone:832-668-5974
Practice Address - Fax:832-668-5984
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor