Provider Demographics
NPI:1356618797
Name:SELMAN GROUP
Entity type:Organization
Organization Name:SELMAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SELMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:409-962-9222
Mailing Address - Street 1:4633 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4713
Mailing Address - Country:US
Mailing Address - Phone:409-962-9222
Mailing Address - Fax:409-962-9451
Practice Address - Street 1:4633 MAIN AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4713
Practice Address - Country:US
Practice Address - Phone:409-962-9222
Practice Address - Fax:409-962-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC-6773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001850901Medicaid
TXU57261Medicare UPIN
TX001850901Medicaid