Provider Demographics
NPI:1174623763
Name:WASSENBERG, DAVID MARK (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:WASSENBERG
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 1:3313 ANDREWS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5148
Mailing Address - Country:US
Mailing Address - Phone:432-697-9797
Mailing Address - Fax:432-697-6891
Practice Address - Street 1:3313 ANDREWS HWY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5148
Practice Address - Country:US
Practice Address - Phone:432-697-9797
Practice Address - Fax:432-697-6891
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F24570Medicare PIN
TX603127Medicare PIN