Provider Demographics
NPI:1154093276
Name:POULTER, COLE P (DC)
Entity Type:Individual
Prefix:DR
First Name:COLE
Middle Name:P
Last Name:POULTER
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 1:109 SUMMER OAK CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6891
Mailing Address - Country:US
Mailing Address - Phone:512-639-3711
Mailing Address - Fax:
Practice Address - Street 1:901 CYPRESS CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4132
Practice Address - Country:US
Practice Address - Phone:512-531-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor