Provider Demographics
NPI:1164690020
Name:DEVOS, WIM L (DC)
Entity Type:Individual
Prefix:
First Name:WIM
Middle Name:L
Last Name:DEVOS
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 1:170 PLAYERS CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6942
Mailing Address - Country:US
Mailing Address - Phone:817-488-8837
Mailing Address - Fax:817-488-8927
Practice Address - Street 1:170 PLAYERS CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6942
Practice Address - Country:US
Practice Address - Phone:817-488-8837
Practice Address - Fax:817-488-8927
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8031111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU96454Medicare UPIN