Provider Demographics
NPI:1528263605
Name:ONDRACEK, CODY MILTON (DC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:MILTON
Last Name:ONDRACEK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2702
Mailing Address - Country:US
Mailing Address - Phone:936-760-3332
Mailing Address - Fax:936-760-3223
Practice Address - Street 1:611 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2702
Practice Address - Country:US
Practice Address - Phone:936-760-3332
Practice Address - Fax:936-760-3223
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor