Provider Demographics
NPI:1346265618
Name:HALLISEY, THOMAS M (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:HALLISEY
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 1:1140 WESTMONT DR
Mailing Address - Street 2:STE 547
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4363
Mailing Address - Country:US
Mailing Address - Phone:713-455-7074
Mailing Address - Fax:713-455-5777
Practice Address - Street 1:1140 WESTMONT DR
Practice Address - Street 2:547
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4363
Practice Address - Country:US
Practice Address - Phone:713-455-7074
Practice Address - Fax:713-455-5777
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084068801Medicaid
TX89V401Medicare PIN