Provider Demographics
NPI:1053433862
Name:VALDEZ, BRYAN ANTHONY SR (DC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ANTHONY
Last Name:VALDEZ
Suffix:SR
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 1:2702 MCKINNEY AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8544
Mailing Address - Country:US
Mailing Address - Phone:214-871-3332
Mailing Address - Fax:214-720-2288
Practice Address - Street 1:2702 MCKINNEY AVE
Practice Address - Street 2:STE 202
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8544
Practice Address - Country:US
Practice Address - Phone:214-871-3332
Practice Address - Fax:214-720-2288
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor