Provider Demographics
NPI:1356394084
Name:KAUFMAN, AGNES C (DC)
Entity type:Individual
Prefix:DR
First Name:AGNES
Middle Name:C
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AGNES
Other - Middle Name:C
Other - Last Name:BARBOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:125 BLUE HERON DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-3183
Mailing Address - Country:US
Mailing Address - Phone:936-582-0404
Mailing Address - Fax:936-582-0410
Practice Address - Street 1:125 BLUE HERON DR
Practice Address - Street 2:SUITE B
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77316-3183
Practice Address - Country:US
Practice Address - Phone:936-582-0404
Practice Address - Fax:936-582-0410
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0921417Medicaid
OH000000382250OtherANTHEM
OH05397OtherPARAMOUNT
OH735038OtherBUCKEYE
OHP00293886OtherRAILROAD MEDICARE
OH0921417Medicaid
OHZE0733766Medicare Oscar/Certification
ZE0733765Medicare PIN
OH000000382250OtherANTHEM
OHP00293886OtherRAILROAD MEDICARE