Provider Demographics
NPI:1336514280
Name:CAMP WISDOM BACK & NECK CARE CENTER
Entity Type:Organization
Organization Name:CAMP WISDOM BACK & NECK CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-296-6173
Mailing Address - Street 1:217 E CAMP WISDOM RD STE D
Mailing Address - Street 2:NONE
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-2769
Mailing Address - Country:US
Mailing Address - Phone:972-296-6173
Mailing Address - Fax:972-296-6192
Practice Address - Street 1:217 E CAMP WISDOM RD STE D
Practice Address - Street 2:NONE
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-2769
Practice Address - Country:US
Practice Address - Phone:972-296-6173
Practice Address - Fax:972-296-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty