Provider Demographics
NPI:1003828401
Name:HILLIARD, CHARLES COLLIN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:COLLIN
Last Name:HILLIARD
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 1:12233 RANCH ROAD 620 N STE 107
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1068
Mailing Address - Country:US
Mailing Address - Phone:512-331-9999
Mailing Address - Fax:512-219-0177
Practice Address - Street 1:12233 RANCH ROAD 620 N STE 107
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1068
Practice Address - Country:US
Practice Address - Phone:512-331-9999
Practice Address - Fax:512-219-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G2141OtherBC/BS
TXU91988Medicare UPIN
TX8948B9Medicare ID - Type Unspecified