Provider Demographics
NPI:1275764060
Name:WATTERS CREEK CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:WATTERS CREEK CHIROPRACTIC, PLLC
Other - Org Name:WATTERS CREEK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEHBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CKTP
Authorized Official - Phone:214-495-6400
Mailing Address - Street 1:614 S. WATTERS RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013
Mailing Address - Country:US
Mailing Address - Phone:214-495-6400
Mailing Address - Fax:
Practice Address - Street 1:614 S. WATTERS RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013
Practice Address - Country:US
Practice Address - Phone:214-495-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty