Provider Demographics
NPI:1467755892
Name:WILLIAM S. UTHLAUT D.C.,P.C.
Entity Type:Organization
Organization Name:WILLIAM S. UTHLAUT D.C.,P.C.
Other - Org Name:BROADWAY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STAFFORD
Authorized Official - Last Name:UTHLAUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-226-2225
Mailing Address - Street 1:6450 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5943
Mailing Address - Country:US
Mailing Address - Phone:972-226-2225
Mailing Address - Fax:972-226-2238
Practice Address - Street 1:6450 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5943
Practice Address - Country:US
Practice Address - Phone:972-226-2225
Practice Address - Fax:972-226-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB119353Medicare PIN