Provider Demographics
NPI:1487847067
Name:WHEELER CHIROPRACTIC & SPORTS INJURY
Entity Type:Organization
Organization Name:WHEELER CHIROPRACTIC & SPORTS INJURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FIAMA
Authorized Official - Phone:409-384-5763
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-0014
Mailing Address - Country:US
Mailing Address - Phone:409-384-5763
Mailing Address - Fax:409-384-1590
Practice Address - Street 1:145 CURTIS ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4505
Practice Address - Country:US
Practice Address - Phone:409-384-5763
Practice Address - Fax:409-384-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC8752OtherLICENSE
TX152536301Medicaid
TX8F3670OtherBLUE CROSS BLUE SHIELD
TX00070TMedicare PIN