Provider Demographics
NPI:1962586008
Name:ONDRACEK, MILTON LOREN (DC)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:LOREN
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
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301
Mailing Address - Country:US
Mailing Address - Phone:936-760-3332
Mailing Address - Fax:936-760-3223
Practice Address - Street 1:611 W DAVIS
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301
Practice Address - Country:US
Practice Address - Phone:936-760-3332
Practice Address - Fax:936-760-3223
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y02656Medicare UPIN
603268Medicare ID - Type Unspecified