Provider Demographics
NPI:1902122450
Name:PAVLOVSKY, GRACE (DC)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:PAVLOVSKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ABNER JACKSON PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5156
Mailing Address - Country:US
Mailing Address - Phone:979-480-9922
Mailing Address - Fax:979-480-9923
Practice Address - Street 1:113 ABNER JACKSON PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5156
Practice Address - Country:US
Practice Address - Phone:979-480-9922
Practice Address - Fax:979-480-9923
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612924Medicare PIN