Provider Demographics
NPI:1942613153
Name:CHAMPIONS CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:CHAMPIONS CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:ROYSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-440-6355
Mailing Address - Street 1:3960 CYPRESS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3521
Mailing Address - Country:US
Mailing Address - Phone:281-440-6355
Mailing Address - Fax:
Practice Address - Street 1:3960 CYPRESS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3521
Practice Address - Country:US
Practice Address - Phone:281-440-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4295111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX129480Medicare PIN