Provider Demographics
NPI:1689781429
Name:TILLOTSON, CHARLES DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:TILLOTSON
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 1:1124 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2958
Mailing Address - Country:US
Mailing Address - Phone:940-382-6141
Mailing Address - Fax:940-382-3992
Practice Address - Street 1:1124 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2958
Practice Address - Country:US
Practice Address - Phone:940-382-6141
Practice Address - Fax:940-382-3992
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G3257OtherBLUE CROSS BLUE SHIELD
TX00290YMedicare ID - Type UnspecifiedMEDICARE