Provider Demographics
NPI:1780112920
Name:PTACNIK, DAVID (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PTACNIK
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 1:3770 CALLE BUENOS AIRES
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1168
Mailing Address - Country:US
Mailing Address - Phone:956-226-4354
Mailing Address - Fax:
Practice Address - Street 1:3770 CALLE BUENOS AIRES
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1168
Practice Address - Country:US
Practice Address - Phone:408-484-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2022-08-24
Deactivation Date:2020-01-17
Deactivation Code:
Reactivation Date:2022-08-24
Provider Licenses
StateLicense IDTaxonomies
TX13477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor