Provider Demographics
NPI:1861750952
Name:WILLIAMSON CHIROPRACTIC OFFICE INC.
Entity type:Organization
Organization Name:WILLIAMSON CHIROPRACTIC OFFICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-944-1441
Mailing Address - Street 1:3219 BURKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1826
Mailing Address - Country:US
Mailing Address - Phone:713-944-1441
Mailing Address - Fax:713-941-2089
Practice Address - Street 1:3219 BURKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1826
Practice Address - Country:US
Practice Address - Phone:713-944-1441
Practice Address - Fax:713-941-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
600869OtherMEDICARE BLUE CROSS BLUE SHIELD
TX0010746-01Medicaid
T16664Medicare UPIN