Provider Demographics
NPI:1497019723
Name:MCDOUGAL, MIA ADAMS (DC)
Entity Type:Individual
Prefix:DR
First Name:MIA
Middle Name:ADAMS
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2415
Mailing Address - Country:US
Mailing Address - Phone:903-838-5883
Mailing Address - Fax:
Practice Address - Street 1:1718 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2415
Practice Address - Country:US
Practice Address - Phone:903-838-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1902968415OtherNPI