Provider Demographics
NPI:1689173320
Name:THWAITES, RICHARD DAVID (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DAVID
Last Name:THWAITES
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 1:950 E STATE HIGHWAY 114 STE 160-108
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5240
Mailing Address - Country:US
Mailing Address - Phone:214-205-2661
Mailing Address - Fax:214-481-1240
Practice Address - Street 1:950 E STATE HIGHWAY 114 STE 160-108
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5240
Practice Address - Country:US
Practice Address - Phone:214-205-2661
Practice Address - Fax:214-481-1240
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty