Organization
BRENT BULTEMEIER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT STEWART BULTEMEIER D.C. (PRESIDENT)
(903) 832-8765
Entity
Organization
Contact information
Practice address
3207 NEW BOSTON ROAD, TEXARKANA, TX 75501
(903) 832-8765
(903) 832-6060
Mailing address
3207 NEW BOSTON ROAD, TEXARKANA, TX 75501
(903) 832-8765
(903) 832-6060
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5532
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0072QD
BLUE CROSS BLUE SHIELD OF TX
TX
01
—
DE5478
RAILROAD MEDICARE
TX
Enumeration date
03/28/2007
Last updated
08/20/2008
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