Provider Demographics
NPI:1235213711
Name:GUILLORY, BRUCE MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARTIN
Last Name:GUILLORY
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 1:18477 WEST LAKE HOUSTON PKWY
Mailing Address - Street 2:STE 70
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346
Mailing Address - Country:US
Mailing Address - Phone:281-852-5600
Mailing Address - Fax:281-852-5613
Practice Address - Street 1:18477 WEST LAKE HOUSTON PKWY
Practice Address - Street 2:STE 70
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346
Practice Address - Country:US
Practice Address - Phone:281-852-5600
Practice Address - Fax:281-852-5613
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606103OtherBCBSH
89M821Medicare UPIN
609434Medicare ID - Type Unspecified