Provider Demographics
NPI:1598771347
Name:HILBORN, CHALES ALLEN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:CHALES
Middle Name:ALLEN
Last Name:HILBORN
Suffix:JR
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:PO BOX 1813
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77572-1813
Mailing Address - Country:US
Mailing Address - Phone:281-470-9244
Mailing Address - Fax:281-470-9249
Practice Address - Street 1:401 W FAIRMONT PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6307
Practice Address - Country:US
Practice Address - Phone:281-470-9244
Practice Address - Fax:281-470-9249
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U57216Medicare UPIN
609110Medicare ID - Type Unspecified