Provider Demographics
NPI:1851495212
Name:HALTERMAN, MARCY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:
Last Name:HALTERMAN
Suffix:
Gender:F
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 133
Mailing Address - Street 2:#222
Mailing Address - City:WELLBORN
Mailing Address - State:TX
Mailing Address - Zip Code:77881-0133
Mailing Address - Country:US
Mailing Address - Phone:979-696-1995
Mailing Address - Fax:979-694-2788
Practice Address - Street 1:1605 ROCK PRAIRIE
Practice Address - Street 2:#222
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845
Practice Address - Country:US
Practice Address - Phone:979-696-1995
Practice Address - Fax:979-694-2788
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15744401Medicaid
TXTXB130598Medicare PIN
TX15744401Medicaid