Provider Demographics
NPI:1972713105
Name:DOMINGUEZ, BRYAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DAVID
Last Name:DOMINGUEZ
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 1:4115 JETTY TERRACE CIR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1705
Mailing Address - Country:US
Mailing Address - Phone:832-640-0493
Mailing Address - Fax:713-521-0852
Practice Address - Street 1:5445 ALMEDA RD
Practice Address - Street 2:STE 403
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7434
Practice Address - Country:US
Practice Address - Phone:713-521-0571
Practice Address - Fax:713-521-0852
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor