Provider Demographics
NPI:1417166992
Name:GREENS BAYOU CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:GREENS BAYOU CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-451-1400
Mailing Address - Street 1:12655 WOODFOREST BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3574
Mailing Address - Country:US
Mailing Address - Phone:713-451-1400
Mailing Address - Fax:713-451-1411
Practice Address - Street 1:12655 WOODFOREST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3574
Practice Address - Country:US
Practice Address - Phone:713-451-1400
Practice Address - Fax:713-451-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2889111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0780OtherBLUE CROSS
TX350017778OtherRR MEDICARE
TX87W330OtherPROVIDER NUMBER
TX431092OtherACN UNITED
TX4361054OtherAETNA
TX046155001Medicaid
TX431092OtherACN UNITED
TX350017778OtherRR MEDICARE