Provider Demographics
NPI:1467450460
Name:WILLMON, PAUL ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:WILLMON
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 1:15202 MASON RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-9911
Mailing Address - Country:US
Mailing Address - Phone:281-256-8100
Mailing Address - Fax:281-256-8163
Practice Address - Street 1:15202 MASON RD
Practice Address - Street 2:SUITE 800
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-9911
Practice Address - Country:US
Practice Address - Phone:281-256-8100
Practice Address - Fax:281-256-8163
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20-5670504OtherTAX IDENTIFICATION NUMBER
TXU76932Medicare UPIN
TX609279Medicare ID - Type Unspecified