Provider Demographics
NPI:1295747921
Name:BREWER, RICHARD TODD (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TODD
Last Name:BREWER
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 1:2501 PAREDES LINE RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1193
Mailing Address - Country:US
Mailing Address - Phone:956-544-0322
Mailing Address - Fax:956-982-4229
Practice Address - Street 1:2501 PAREDES LINE RD
Practice Address - Street 2:SUITE B2
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1193
Practice Address - Country:US
Practice Address - Phone:956-544-0322
Practice Address - Fax:956-982-4229
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000K48Q2Medicaid
TXZ000K48Q2Medicaid
TX00K48QBCBSMedicare ID - Type UnspecifiedMEDICARE GROUP
TX88T851Medicare ID - Type Unspecified