=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174700181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONDRACEK CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2008
-----------------------------------------------------
Last Update Date | 09/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 W DAVIS ST
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-760-3332
-----------------------------------------------------
Fax | 936-760-3223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 W DAVIS ST
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77301-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 936-760-3223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. MILTON ONDRACEK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 936-760-3332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 5282
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------