Provider Demographics
NPI:1336322635
Name:TILLOTSON & NIX CHIROPRACTIC CENTER,P.C.
Entity Type:Organization
Organization Name:TILLOTSON & NIX CHIROPRACTIC CENTER,P.C.
Other - Org Name:THE FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:TILLOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:940-382-6141
Mailing Address - Street 1:1124 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2958
Mailing Address - Country:US
Mailing Address - Phone:940-382-6141
Mailing Address - Fax:940-382-3992
Practice Address - Street 1:1124 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2958
Practice Address - Country:US
Practice Address - Phone:940-382-6141
Practice Address - Fax:940-382-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV03838Medicare UPIN