Provider Demographics
NPI:1558554279
Name:HOUGHTON, DERRICK W (DC)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:W
Last Name:HOUGHTON
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 1:16301 YELLOW SAGE ST
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3520
Mailing Address - Country:US
Mailing Address - Phone:512-252-9444
Mailing Address - Fax:512-252-9341
Practice Address - Street 1:16301 YELLOW SAGE ST
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3520
Practice Address - Country:US
Practice Address - Phone:512-252-9444
Practice Address - Fax:512-252-9341
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88880YOtherBLUE CROSS ID
TX123-515-3966OtherGROUP NPI
TX609358Medicare PIN
TXU79683Medicare UPIN