Provider Demographics
NPI:1417966730
Name:BOOTH, WILLIAM C (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:BOOTH
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 1:1621 W PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3502
Mailing Address - Country:US
Mailing Address - Phone:817-460-4644
Mailing Address - Fax:817-460-4641
Practice Address - Street 1:1621 W PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-3502
Practice Address - Country:US
Practice Address - Phone:817-460-4644
Practice Address - Fax:817-460-4641
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
86M321Medicare PIN
TXU09884Medicare UPIN