Provider Demographics
NPI:1255334520
Name:TILLMANN, RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TILLMANN
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 1:9902 SAGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5013
Mailing Address - Country:US
Mailing Address - Phone:281-333-9355
Mailing Address - Fax:281-481-9355
Practice Address - Street 1:9902 SAGEDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-5013
Practice Address - Country:US
Practice Address - Phone:281-333-9355
Practice Address - Fax:281-481-9355
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX6340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX604089OtherBLUE CROSS BLUE SHIELD
TX604089Medicare ID - Type Unspecified