Provider Demographics
NPI:1235379157
Name:ROCKWALL PRO HEALTH CHIROPRACTIC
Entity Type:Organization
Organization Name:ROCKWALL PRO HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-771-3388
Mailing Address - Street 1:554 W RALPH HALL PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6644
Mailing Address - Country:US
Mailing Address - Phone:972-771-3388
Mailing Address - Fax:972-722-3398
Practice Address - Street 1:554 W RALPH HALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6644
Practice Address - Country:US
Practice Address - Phone:972-771-3388
Practice Address - Fax:972-722-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11131111N00000X
TX11026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4697Medicare PIN