Provider Demographics
NPI:1164701405
Name:TEXAS INSTITUTE OF SPORTS MEDICINE AND WEIGHT MANAGEMENT
Entity Type:Organization
Organization Name:TEXAS INSTITUTE OF SPORTS MEDICINE AND WEIGHT MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-279-4039
Mailing Address - Street 1:2147 NECTAR DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-8657
Mailing Address - Country:US
Mailing Address - Phone:469-279-4039
Mailing Address - Fax:
Practice Address - Street 1:219 S CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4528
Practice Address - Country:US
Practice Address - Phone:469-279-4039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6507111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty