Provider Demographics
NPI:1073899324
Name:DEVOS CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:DEVOS CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-989-1363
Mailing Address - Street 1:304 KING RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6427
Mailing Address - Country:US
Mailing Address - Phone:972-989-1363
Mailing Address - Fax:
Practice Address - Street 1:1959 W SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6713
Practice Address - Country:US
Practice Address - Phone:972-989-1363
Practice Address - Fax:817-488-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8031261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center