Provider Demographics
NPI:1487961686
Name:KATY CHIROPRACTIC ASSOCIATES, INC.
Entity type:Organization
Organization Name:KATY CHIROPRACTIC ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-398-1113
Mailing Address - Street 1:777 S FRY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2297
Mailing Address - Country:US
Mailing Address - Phone:281-398-1113
Mailing Address - Fax:281-398-1114
Practice Address - Street 1:777 S FRY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2297
Practice Address - Country:US
Practice Address - Phone:281-398-1113
Practice Address - Fax:281-398-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB118973Medicare PIN