Provider Demographics
NPI:1407097173
Name:DEWALCH, DANIEL WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WAYNE
Last Name:DEWALCH
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 1:4295 SAN FELIPE ST
Mailing Address - Street 2:#230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2942
Mailing Address - Country:US
Mailing Address - Phone:713-629-9200
Mailing Address - Fax:
Practice Address - Street 1:4295 SAN FELIPE ST
Practice Address - Street 2:#230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-2942
Practice Address - Country:US
Practice Address - Phone:713-629-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9740111NS0005X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No171100000XOther Service ProvidersAcupuncturist