Provider Demographics
NPI:1417017609
Name:PRIOUX, MICHAEL ROLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROLAND
Last Name:PRIOUX
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 1:3300 PEBBLEBROOK DR
Mailing Address - Street 2:# 24
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-6056
Mailing Address - Country:US
Mailing Address - Phone:832-221-9035
Mailing Address - Fax:
Practice Address - Street 1:2407 W PARKWOOD AVE
Practice Address - Street 2:SUITE #111
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-8945
Practice Address - Country:US
Practice Address - Phone:281-996-1100
Practice Address - Fax:281-996-1623
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX606318OtherBLUE CROSS BLUE SHIELD
TX606318OtherBLUE CROSS BLUE SHIELD
TXU88122Medicare UPIN