Provider Demographics
NPI:1225109580
Name:MACK, PRESTON C (DC)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:C
Last Name:MACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 POST OAK PLACE DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3161
Mailing Address - Country:US
Mailing Address - Phone:713-627-7223
Mailing Address - Fax:713-963-8011
Practice Address - Street 1:4544 POST OAK PLACE DR
Practice Address - Street 2:SUITE 275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3161
Practice Address - Country:US
Practice Address - Phone:713-627-7223
Practice Address - Fax:713-963-8011
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU57954Medicare UPIN
TX605260Medicare ID - Type Unspecified