MEDICARE: ERIC S KUCERA 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	DC7950	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00379816	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	605855	OTHER	TX	BCBS
3	DC7950	OTHER	TX	WC

General Provider Information

NPI Number	:	1770690166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC S KUCERA DC

Provider Business Mailing Address
First Line	:	107 LIVE OAK DR
Second Line	:
City	:	VAN VLECK
State	:	TX
Zip	:	77482-9764
Country	:	US
Telephone Number	:	979-335-4500
Fax Number	:	979-335-4545

Provider Business Practice Location Address
First Line	:	1131 A MAIN
Second Line	:
City	:	EAST BERNARD
State	:	TX
Zip	:	77435-9227
Country	:	US
Telephone Number	:	979-335-4500
Fax Number	:	979-335-4545

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	05/13/2008

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Directions to “ ERIC S KUCERA DC” Practice Location

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