Provider Demographics
NPI:1134519127
Name:VAN BLARCUM, MIRANDA (DC RD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:VAN BLARCUM
Suffix:
Gender:F
Credentials:DC RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E MLK BLVD # 111
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2105 E MLK BLVD # 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1341
Practice Address - Country:US
Practice Address - Phone:512-309-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13538111N00000X
TXDT92549133V00000X
VA0104-557227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13538OtherTEXAS BOARD OF CHIROPRACTIC EXAMINERS