Provider Demographics
NPI:1053322420
Name:THEPPOTE, TOOLE KEN (DC)
Entity Type:Individual
Prefix:DR
First Name:TOOLE
Middle Name:KEN
Last Name:THEPPOTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:KEN
Other - Middle Name:TOOLE
Other - Last Name:THEPPOTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1455 BUCKINGHAM RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5361
Mailing Address - Country:US
Mailing Address - Phone:972-644-7246
Mailing Address - Fax:972-644-7244
Practice Address - Street 1:1455 BUCKINGHAM RD
Practice Address - Street 2:SUITE 140
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5361
Practice Address - Country:US
Practice Address - Phone:972-644-7246
Practice Address - Fax:972-644-7244
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor