Provider Demographics
NPI:1407032592
Name:L BERT WILLIAMS DC PC
Entity Type:Organization
Organization Name:L BERT WILLIAMS DC PC
Other - Org Name:CHAMPIONS CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LOVELACE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-440-6355
Mailing Address - Street 1:3960 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3521
Mailing Address - Country:US
Mailing Address - Phone:281-440-6355
Mailing Address - Fax:281-440-0401
Practice Address - Street 1:3960 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3521
Practice Address - Country:US
Practice Address - Phone:281-440-6355
Practice Address - Fax:281-440-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00966VMedicare PIN