Provider Demographics
NPI:1831480623
Name:CATHRYN W KOLKER DCPC
Entity Type:Organization
Organization Name:CATHRYN W KOLKER DCPC
Other - Org Name:BACK & JOINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHRYN
Authorized Official - Middle Name:WOEBER
Authorized Official - Last Name:KOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-255-6700
Mailing Address - Street 1:3636 N. MACARTHUR BLVD.
Mailing Address - Street 2:SUITE 185
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3656
Mailing Address - Country:US
Mailing Address - Phone:972-255-6700
Mailing Address - Fax:972-255-0905
Practice Address - Street 1:3636 N. MACARTHUR BLVD.
Practice Address - Street 2:SUITE 185
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3656
Practice Address - Country:US
Practice Address - Phone:972-255-6700
Practice Address - Fax:972-255-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2910111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU14130Medicare UPIN