Provider Demographics
NPI:1265441240
Name:DE LOACHE CH, WILLIAM A
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:DE LOACHE CH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SPRING CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2502
Mailing Address - Country:US
Mailing Address - Phone:281-350-9811
Mailing Address - Fax:281-288-4897
Practice Address - Street 1:1107 SPRING CYPRESS RD
Practice Address - Street 2:SUITEA
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2502
Practice Address - Country:US
Practice Address - Phone:281-350-9811
Practice Address - Fax:281-288-4897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1807Medicare PIN