Provider Demographics
NPI:1518960863
Name:BOOTH, MICHAEL A (DC, DACBN, CCN)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BOOTH
Suffix:
Gender:M
Credentials:DC, DACBN, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10311 W HIDDEN LAKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7708
Mailing Address - Country:US
Mailing Address - Phone:281-342-5941
Mailing Address - Fax:281-342-5953
Practice Address - Street 1:5529 FM 359 RD
Practice Address - Street 2:STE A
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-9659
Practice Address - Country:US
Practice Address - Phone:281-342-5941
Practice Address - Fax:281-342-5953
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6964111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608109OtherBLUE CROSS/BLUE SHIELD
TX608109OtherBLUE CROSS/BLUE SHIELD