Provider Demographics
NPI:1245455930
Name:BRASSARD, RICHARD G (DC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:BRASSARD
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 1:5912 SPENCER HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-1602
Mailing Address - Country:US
Mailing Address - Phone:281-998-6092
Mailing Address - Fax:281-998-0558
Practice Address - Street 1:5912 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-1602
Practice Address - Country:US
Practice Address - Phone:281-998-6092
Practice Address - Fax:281-998-0558
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2221OtherLICENSE NUMBER
TX2221OtherLICENSE NUMBER
TXG01P84K971Medicare ID - Type Unspecified