MEDICARE: DR. AGNES C. KAUFMAN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	12577	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00293886	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000382250	OTHER	OH	ANTHEM
3	05397	OTHER	OH	PARAMOUNT
4	735038	OTHER	OH	BUCKEYE

General Provider Information

NPI Number	:	1356394084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGNES C. KAUFMAN DC

Provider Business Mailing Address
First Line	:	125 BLUE HERON DR
Second Line	:	SUITE B
City	:	MONTGOMERY
State	:	TX
Zip	:	77316-3183
Country	:	US
Telephone Number	:	936-582-0404
Fax Number	:	936-582-0410

Provider Business Practice Location Address
First Line	:	125 BLUE HERON DR
Second Line	:	SUITE B
City	:	MONTGOMERY
State	:	TX
Zip	:	77316-3183
Country	:	US
Telephone Number	:	936-582-0404
Fax Number	:	936-582-0410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	03/24/2017

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Directions to “ DR. AGNES C. KAUFMAN DC” Practice Location

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