Healthcare Provider Details

I. General information

NPI: 1790798726
Provider Name (Legal Business Name): JOHN M VACLAVIK DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 GULF FWY S SUITE G-1
LEAGUE CITY TX
77573-3524
US

IV. Provider business mailing address

212 GULF FWY S SUITE G-1
LEAGUE CITY TX
77573-3524
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-6816
  • Fax: 281-338-9998
Mailing address:
  • Phone: 281-332-6816
  • Fax: 281-338-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5608
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: