Healthcare Provider Details

I. General information

NPI: 1144242074
Provider Name (Legal Business Name): BRIAN STEVEN SCHTUPAK D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 MANZANO ST NE
ALBUQUERQUE NM
87110-6359
US

IV. Provider business mailing address

16932 CRYSTAL LN
HARLINGEN TX
78552-2319
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-7246
  • Fax: 505-344-2666
Mailing address:
  • Phone: 956-821-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10433
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number10433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: