Provider Demographics
NPI:1265274955
Name:MIDDLETON, CHAUNCY
Entity type:Individual
Prefix:
First Name:CHAUNCY
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3281
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-3281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5103 BELLAIRE BLVD
Practice Address - Street 2:UNIT 220, SUITE 201
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-231-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171400000X, 261QC1500X, 261QM2500X
TX866204202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health